Please com­plete this appli­ca­tion form if you are inter­est­ed in par­tic­i­pat­ing in Team Iowa. For gen­er­al appli­ca­tion or Team Iowa pro­gram ques­tions, please con­tact Anna Hobart, Team Man­ag­er at 3196653787 or ahobart@​iadn.​org.

Personal Information

Education / Employment

Personal Background Information

(A conviction record will not necessarily bar team membership. Factors such as age of the offense, seriousness and nature of the violation and rehabilitation will be taken into account.)

Emergency Contact Information

Your Connection to Donation

Team Membership Type and Responsibilities

1. Members must be one of the following: Transplant Recipient (at least 9 months post-transplant by June 2022), Tissue or Cornea Recipient or Living Donor. 2. Raise $750. Participate in Iowa Donor Network's Volunteer Program. Attend all Team Meetings.
1. Includes family members and friends of Team Iowa athletes, OPO and eye bank staff. 2. Supporters will receive a free Team Iowa t-shirt. Additional items (other apparel, pins, etc.) can be purchased separately.

Previous Games Experience

Team Iowa Membership Agreement

I understand and agree to the following terms:

  1. I certify that the information provided in this application is true and correct in all respects without any willful omissions.
  2. I understand that I will be screened at Iowa Donor Network's cost for a background check. The background investigation shall include, but is not limited to: Motor Vehicle Records Check, Social Security Trace, Child Abuse Registry Check, Criminal History Check, Education Verification and/or employment verifications. A positive finding for any of the above, such as a conviction or court-imposed penalty for a crime, may preclude me from consideration as a member of Team Iowa.
  3. I will adhere to Team Iowa's Code of Conduct and Ethics which will be provided to me in detail upon joining the team.
  4. I understand that I am required to provide proof of medical clearance from my physician two months prior to the Transplant Games in August 2022 in order to participate in any events.
  5. I agree to fulfill the fundraising requirements as a member of Team Iowa.

Our Vision:

All are inspired to donate life.