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1
PERSONAL INFO & CONTACT DETAILS
Full Name
Blood Type
A+
B+
O+
AB+
A-
B-
O-
AB-
A+
A-
B+
B-
O+
O-
AB+
AB-
Gender
Select
Male
Female
Date of Birth
Weight
Home Address
Work/University Name & Address
Email
Mobile Number
Home Number
Remarks
2
Questions
Date of latest Blood Donation
(if applicable)
Date of latest Platelet Donation
(if applicable)
Would you like to donate platelets?
Yes
No
How did you hear about DSC?
Friends
Family
Facebook
Blog
News
Other
3
AGREEMENT & CONFIRMATION
I am aware that DONNER SANG COMPTER will use my information to respond to my queries and comments and will not disclose my information to a third party.
CONFIRM