<!-- BOF: ./personal-templates/show.body -->
<!-- BOF: ./personal-templates/simple/generic/show -->
<!-- BOF: ./personal-templates/simple/generic/functions -->
<!-- BOF: ./personal-templates/simple/generic/navbar --><!-- EOF: ./personal-templates/simple/generic/navbar -->


<!-- EOF: ./personal-templates/simple/generic/functions -->


<!-- EOF: ./personal-templates/simple/generic/show -->

<!-- BOF: ./personal-templates/simple/generic/images -->

<!-- EOF: ./personal-templates/simple/generic/images -->


  <!-- BOF: ./personal-templates/simple/business/layout/l49.wait -->


<!-- EOF: ./personal-templates/simple/business/layout/l49.wait -->


<HTML>

<HEAD>


<META NAME="description" CONTENT="Kidney Swap allows patients who need a kidney to take  
a proactive approach to find a suitable donor. Often people waiting for a  
kidney transplant have friends or family who are willing and able to make a  
kidney donation, but have tissue or blood characteristics that are  
incompatible and would cause the transplant to be unsuccessful. For  
instance, a person may need a donor with Type A blood and have a  
potential donor who is a blood Type B. Kidney swap allows people with  
healthy, willing, yet incompatible donors to meet others who are in the  
same dilemma and essentially swap kidneys.">
<META NAME="Keywords"    CONTENT="Kidney, transplant, swap, exchange, hospital, organ, donation, organ donation, trade, surgery, liver, ">


<!-- business -->


<META HTTP-EQUIV="Content-Type" CONTENT="text/html; charset=UTF-8">
<META NAME="Generator" content="">
<!-- BOF: ./personal-templates/simple/themes.show -->


<!-- EOF: ./personal-templates/simple/themes.show -->


<!--<BASE HREF="http://onlinekidneyswap.com/organdonation.html">-->
<TITLE>Donate Life - To list the tissue or an organ you would like to donate please enter your information below.</TITLE></head>
<BODY  BGCOLOR="#EDE4D9"
 TEXT="#333333"

LEFTMARGIN="0" TOPMARGIN="0" RIGHTMARGIN="0" BOTTOMMARGIN="0"

 onLoad=""
 
 LINK="#66CC66"
 VLINK="#000000"
 ALINK="#66CC66"
>

  
      <!-- BOF: ./personal-templates/simple/business/layout/l49.layout --> 

<!-- html -->

<!-- Begin Header -->
    <TABLE WIDTH="100%" HEIGHT="100%" BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="top">
      <TR>
         <TD ALIGN="center" HEIGHT=174 BGCOLOR="#73593B" COLSPAN=3>
            <TABLE WIDTH="100%" HEIGHT=174 BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="top" ALIGN="center">
              <TR>
                <TD WIDTH="50%" HEIGHT=174 BACKGROUND="widgets/gen_45.1.gif">
                   <IMG SRC="widgets/spacer.gif" WIDTH=1 HEIGHT=1></TD>
                <TD ALIGN="center" WIDTH=746 HEIGHT=174>
                  <TABLE WIDTH="100%" HEIGHT="100%" BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="top" ALIGN="center">
                     <TR>
                       <TD WIDTH=746 HEIGHT=174 VALIGN="top">
                         <IMG SRC="widgets/gen_55.1.gif" WIDTH=746 HEIGHT=174 ALT="" BORDER="0"></TD>
                    </TR>
                  </TABLE>
               </TD>
               <TD WIDTH="50%" HEIGHT=174 BACKGROUND="widgets/gen_45.1.gif">
                   <IMG SRC="widgets/spacer.gif" WIDTH=1 HEIGHT=1></TD>
             </TR>
          </TABLE>
      </TD>
      </TR>
<!-- END Header -->

<!-- Begin Pol -->
     <TR>
        <TD HEIGHT=19 VALIGN="top" COLSPAN=3>
            <TABLE WIDTH="100%" HEIGHT="100%" BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="top" ALIGN="center">
              <TR>
                 <TD WIDTH=18 HEIGHT=19 ALIGN="left">
                    <IMG SRC="widgets/gen_42.1.gif" WIDTH=18 HEIGHT=19 ALT="" BORDER="0"></TD>
                 <TD WIDTH="100%" BACKGROUND="widgets/gen_41.1.gif">
                    <IMG SRC="widgets/spacer.gif" WIDTH=1 HEIGHT=1></TD>
                 <TD WIDTH=16 HEIGHT=19 ALIGN="right">
                    <IMG SRC="widgets/gen_43.1.gif" WIDTH=16 HEIGHT=19 ALT="" BORDER="0"></TD>
             </TR>
          </TABLE>
     </TD>
   </TR>
<!-- END Pol -->

<!-- Begin Center -->
   <TR>
       <TD WIDTH=50% BACKGROUND="widgets/gen_48.1.gif">
           <IMG SRC="widgets/spacer.gif" WIDTH=1 HEIGHT=1></TD>
       <TD WIDTH=746>
           <TABLE WIDTH=746 HEIGHT="100%" BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="top">
              <TR>
<!-- Begin Buttons -->
                 <TD WIDTH=188 HEIGHT=100% VALIGN="top" BACKGROUND="widgets/gen_46.1.gif">
                    <TABLE WIDTH=188 HEIGHT="100%" BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="top" BGCOLOR="#EDE4D9" BACKGROUND="widgets/gen_46.1.gif">
                        <TR>
                           <TD HEIGHT=10 VALIGN="top">
                              <IMG SRC="widgets/spacer.gif" WIDTH=188 HEIGHT=10></TD>
                        </TR>
                        <TR>
                           <TD WIDTH="188" ALIGN="center" VALIGN="top">
               
               
               <a href="index.html" onMouseOver="document.images['img7'].src='widgets/gen_57.1.gif'" onMouseOut="document.images['img7'].src='widgets/gen_56.1.gif'"><img src="widgets/gen_56.1.gif" alt="Welcome" name="img7" border="0"></a><br>
               <a href="gpage.html" onMouseOver="document.images['img8'].src='widgets/gen_50.1.gif'" onMouseOut="document.images['img8'].src='widgets/gen_49.1.gif'"><img src="widgets/gen_49.1.gif" alt="About" name="img8" border="0"></a><br>
               <a href="considerthis.html" onMouseOver="document.images['img10'].src='widgets/gen_83.1.gif'" onMouseOut="document.images['img10'].src='widgets/gen_82.1.gif'"><img src="widgets/gen_82.1.gif" alt="Consider This" name="img10" border="0"></a><br>
               <a href="news.html" onMouseOver="document.images['img12'].src='widgets/gen_85.1.gif'" onMouseOut="document.images['img12'].src='widgets/gen_84.1.gif'"><img src="widgets/gen_84.1.gif" alt="News" name="img12" border="0"></a><br>
               
               <a href="faq.html" onMouseOver="document.images['img15'].src='widgets/gen_100.1.gif'" onMouseOut="document.images['img15'].src='widgets/gen_99.1.gif'"><img src="widgets/gen_99.1.gif" alt="FAQ" name="img15" border="0"></a><br>
               <a href="donorpost.html" onMouseOver="document.images['img33'].src='widgets/gen_112.1.gif'" onMouseOut="document.images['img33'].src='widgets/gen_111.1.gif'"><img src="widgets/gen_111.1.gif" alt="Misc. Donor Post" name="img33" border="0"></a><br>
               <a href="external.html" onMouseOver="document.images['img36'].src='widgets/gen_116.1.gif'" onMouseOut="document.images['img36'].src='widgets/gen_115.1.gif'"><img src="widgets/gen_115.1.gif" alt="Login" name="img36" border="0"></a><br>
               <a href="form1.html" onMouseOver="document.images['img42'].src='widgets/gen_126.1.gif'" onMouseOut="document.images['img42'].src='widgets/gen_125.1.gif'"><img src="widgets/gen_125.1.gif" alt="Advertise" name="img42" border="0"></a><br>
               
               
               <a href="gpage2.html" onMouseOver="document.images['img96'].src='widgets/gen_186.1.gif'" onMouseOut="document.images['img96'].src='widgets/gen_185.1.gif'"><img src="widgets/gen_185.1.gif" alt="Free Services" name="img96" border="0"></a><br>
               
               <a href="organdonation.html" onMouseOver="document.images['img135'].src='widgets/gen_200.1.gif'" onMouseOut="document.images['img135'].src='widgets/gen_199.1.gif'"><img src="widgets/gen_199.1.gif" alt="Donate Life" name="img135" border="0"></a><br><a href="mailto:administrator@onlinekidneyswap.com" onMouseOver="document.images['img_email'].src='widgets/gen_52.1.gif'" onMouseOut="document.images['img_email'].src='widgets/gen_51.1.gif'"><img src="widgets/gen_51.1.gif" alt="e-mail me" name="img_email" border="0"></a><br></TD>
                           </TD>
                       </TR>
                 </TABLE>
               </TD>
<!-- END Buttons -->
<!-- Begin body -->        
              <TD WIDTH=100% HEIGHT="100%" VALIGN="top">
                 <TABLE WIDTH=100% HEIGHT="100%" BORDER="0" CELLPADDING="10" CELLSPACING="0" VALIGN="top">
                   <TR>
                      <TD WIDTH=100% VALIGN="top"><!-- BOF: ./personal-templates/simple/business/form/html -->
<!-- BOF: ./personal-templates/simple/personal/form/html -->


<center><table border="0"><tr><td>


<font face='Arial' size='+1' color='#66CC66'>

Donate Life - To list the tissue or an organ you would like to donate please enter your information below.

</font>


<br>
<SCRIPT LANGUAGE="JavaScript">
function validate(){
    var valid;
        valid=true;
        var valueExists;


if (document.forms[0].field_139.value==""){ valid=false; };


if (document.forms[0].field_140.value==""){ valid=false; };


if (document.forms[0].field_141.value==""){ valid=false; };


if (document.forms[0].field_142.value==""){ valid=false; };


    valueExists = false;
    for (var i = 0; i < document.forms[0].field_143.length; i++)
    {
    if (document.forms[0].field_143[i].checked) {
        valueExists = true;
        break
    }
    }
    if (valueExists==false) valid=false;


if (document.forms[0].field_144.value==""){ valid=false; };


if (document.forms[0].field_148.value==""){ valid=false; };


if (document.forms[0].field_149.value==""){ valid=false; };


if (document.forms[0].field_150.value==""){ valid=false; };


if (valid==false) {
        alert('You did not fill all required fields!');
        }

return valid;
}
</SCRIPT>

<form name="questionary" action="http://supremecenter44.com:8080/servlet/psoft.customform.CustomForm" method="post">
<input type="hidden" name="form_id" value="135">
<input type="hidden" name="user_id" value="1684">
<input type="hidden" name="title" value="Donate Life - To list the tissue or an organ you would like to donate please enter your information below.">

<input type="hidden" name="name" value="email4.html">


<input type="hidden" name="order" value="139 140 141 142 143 144 145 146 147 148 149 150 ">
<input type="hidden" name="submit_url" value="http://onlinekidneyswap.com/onsubmit4.html">
<input type="hidden" name="error_url" value="http://onlinekidneyswap.com/onerror4.html">
<table border="0">

<input type="hidden" name="name_139" value="Name">
<tr><td>


<font face='Arial' size='2' color='#333333'>

Name

</font>


 <font color="red" size="-1">*</font></td><td>


<input type="text" name="field_139">


</td></tr>

<input type="hidden" name="name_140" value="Address">
<tr><td>


<font face='Arial' size='2' color='#333333'>

Address

</font>


 <font color="red" size="-1">*</font></td><td>


<textarea name="field_140" rows="4" cols="30"></textarea>


</td></tr>

<input type="hidden" name="name_141" value="Tissue / Organ Being Donated">
<tr><td>


<font face='Arial' size='2' color='#333333'>

Tissue / Organ Being Donated

</font>


 <font color="red" size="-1">*</font></td><td>


<input type="text" name="field_141">


</td></tr>

<input type="hidden" name="name_142" value="Blood Type">
<tr><td>


<font face='Arial' size='2' color='#333333'>

Blood Type

</font>


 <font color="red" size="-1">*</font></td><td>


<input type="text" name="field_142">


</td></tr>

<input type="hidden" name="name_143" value="Are You Willing to Travel?">
<tr><td>


<font face='Arial' size='2' color='#333333'>

Are You Willing to Travel?

</font>


 <font color="red" size="-1">*</font></td><td>


 <input type="radio" name="field_143" id="field_1431" value="Yes"><label for="field_1431">


<font face='Arial' size='2' color='#333333'>

Yes

</font>


</label> <input type="radio" name="field_143" id="field_1432" value="No"><label for="field_1432">


<font face='Arial' size='2' color='#333333'>

No

</font>


</label>


</td></tr>

<input type="hidden" name="name_144" value="If So, How Far? ">
<tr><td>


<font face='Arial' size='2' color='#333333'>

If So, How Far? 

</font>


 <font color="red" size="-1">*</font></td><td>


<input type="text" name="field_144">


</td></tr>

<input type="hidden" name="name_145" value="Preferences">
<tr><td>


<font face='Arial' size='2' color='#333333'>

Preferences

</font>


 </td><td>


<textarea name="field_145" rows="4" cols="30"></textarea>


</td></tr>

<input type="hidden" name="name_146" value="About You">
<tr><td>


<font face='Arial' size='2' color='#333333'>

About You

</font>


 </td><td>


<textarea name="field_146" rows="4" cols="30"></textarea>


</td></tr>

<input type="hidden" name="name_147" value="Where Did You Hear About Us?">
<tr><td>


<font face='Arial' size='2' color='#333333'>

Where Did You Hear About Us?

</font>


 </td><td>


<textarea name="field_147" rows="4" cols="30"></textarea>


</td></tr>

<input type="hidden" name="name_148" value="Choose Log In Name">
<tr><td>


<font face='Arial' size='2' color='#333333'>

Choose Log In Name

</font>


 <font color="red" size="-1">*</font></td><td>


<input type="text" name="field_148">


</td></tr>

<input type="hidden" name="name_149" value="Choose Password">
<tr><td>


<font face='Arial' size='2' color='#333333'>

Choose Password

</font>


 <font color="red" size="-1">*</font></td><td>


<input type="text" name="field_149">


</td></tr>

<input type="hidden" name="name_150" value="Current E-mail Address">
<tr><td>


<font face='Arial' size='2' color='#333333'>

Current E-mail Address

</font>


 <font color="red" size="-1">*</font></td><td>


<input type="text" name="field_150">


</td></tr>

</table>


<input type="submit" onClick="return validate()"> <input type="reset">

</form>
</td></tr></table></center>
<!-- EOF: ./personal-templates/simple/personal/form/html -->

<!-- EOF: ./personal-templates/simple/business/form/html -->
</TD>
                      <TD WIDTH=29 HEIGHT=100% BGCOLOR="#EDE4D9" BACKGROUND="widgets/gen_47.1.gif" ALIGN="right" ROWSPAN=2>
                           <IMG SRC="widgets/spacer.gif" WIDTH=1 HEIGHT=1></TD>
                   </TR>
                   <TR>
                      <TD VALIGN="bottom" WIDTH=100%>
<center><table border="0" cellpadding="0" cellspacing="3"><tr><td align="center">

<br><font face="helvetica,verdana, arial" size="1">&nbsp;</font>

</td></tr></table></center>
</TD>
                  </TR>
               </TABLE>
             </TD>
<!-- END body -->
         </TR>
       </TABLE>
     </TD>
     <TD WIDTH=50% BACKGROUND="widgets/gen_48.1.gif">
         <IMG SRC="widgets/spacer.gif" WIDTH=1 HEIGHT=1></TD>
   </TR>
<!-- END Center -->
<!-- Begin Bottom -->
   <TR>
     <TD VALIGN="bottom" HEIGHT=91 COLSPAN=3>
        <TABLE WIDTH="100%" HEIGHT=91 BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="bottom" ALIGN="center">
          <TR>
            <TD WIDTH=18 HEIGHT=91 ALIGN="left" BACKGROUND="widgets/gen_205.1.gif">
               <IMG SRC="widgets/spacer.gif" WIDTH=18 HEIGHT=91></TD>
            <TD BACKGROUND="widgets/gen_39.1.gif" VALIGN="top">
               <IMG SRC="widgets/spacer.gif" WIDTH=1 HEIGHT=1><br>

<br>
<FONT FACE="verdana, arial, helvetica" SIZE="1">
<center>
<nobr>|<a href="index.html">Welcome</A>|</nobr>

<nobr>|<a href="gpage.html">About</A>|</nobr>

<nobr>|<a href="considerthis.html">Consider This</A>|</nobr>

<nobr>|<a href="news.html">News</A>|</nobr>

<nobr>|<a href="faq.html">FAQ</A>|</nobr>

<nobr>|<a href="donorpost.html">Misc. Donor Post</A>|</nobr>

<nobr>|<a href="external.html">Login</A>|</nobr>

<nobr>|<a href="form1.html">Advertise</A>|</nobr>

<nobr>|<a href="gpage2.html">Free Services</A>|</nobr>

<nobr>|Donate Life|</nobr>
</center>
</font>

</TD>
            <TD WIDTH=16 HEIGHT=91 ALIGN="right" BACKGROUND="widgets/gen_40.1.gif">
               <IMG SRC="widgets/spacer.gif" WIDTH=16 HEIGHT=91></TD>
          </TR>        
       </TABLE>
     </TD>
   </TR>
<!-- END Bottom -->
</TABLE> 
<!-- end html -->
                
<!-- EOF: ./personal-templates/simple/business/layout/l49.layout -->

    
<!-- BOF: ./personal-templates/simple/themes.show.body -->


<!-- EOF: ./personal-templates/simple/themes.show.body -->

</body>
<!-- BOF: ./personal-templates/simple/themes.show.end -->


<!-- EOF: ./personal-templates/simple/themes.show.end -->


</html>


<!-- EOF: ./personal-templates/show.body -->