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If you were referred to pledge by a friend/family, who referred you?

You must be 18 years or older to to pledge your brain to research.

Date of Birth (M/D/YYYY)*
If other, which primary sport?

By making my brain pledge public, I understand the Concussion Legacy Foundation has the right to release the news of my pledge, should it choose to do so, in accordance with these Terms and Conditions.

I understand that this form and the decision to donate my brain is not a legally binding contract between myself and the Concussion Legacy Foundation. The decision to donate my brain will be made by my next of kin.*
  • I confirm I would like to pledge my brain to research after my death.

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