Choose the Microsoft Word or PDF version of the Donation form.

The Word version of the form can either be faxed to the Center at (310) 268-4768 or mailed to the Center at:

Gift of Hope Program (127A)
The Human Brain and Spinal Fluid Resource Center
Building 212 Room 16
VA Greater Los Angeles Healthcare System
West Los Angeles Healthcare Center
11301 Wilshire Blvd.(127A), Los Angeles, CA 90073

The PDF version can either be saved, filled out, and e-mailed to brainbnk@ucla.edu, or it can be filled out and submitted online.

Donation Form (Word version)

Donation Form (PDF)