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Blood Donor Signup

Donor Registration Form

  • We are very glad that you want to signup as donor.
  • To register as a blood donor is a responsibility.
  • Once you are a registered donor, implies that you will be glad or privileged to donate blood at all possible times.
We respect your privacy. We will never rent, sell or give away your email to any third party.
                                                            
Future Login Information
 * Username
 * Password
 * Retype Password

Donor Information
 * Donor Name
 * Gender
 * Date of Birth
    Weight
kgs
 * Blood Group
   Last Donation

(Ex: June 2008 or Before 3 months)
   Frequency

Contact Information
 * Email
 * Mobile No
    Phone No
   Address
 * Country
   State
 * City
  * Zip Code
Message

Form Verification
 * Code
I have read the eligibility criteria and confrim that eligible to donate blood. Important: I authorize the website to display my telephone number, e-mail ID and mailing address so that the needy could contact me, as and when there is an emergency. I will inform the website at info@alishbaa.com as soon as I donate blood so that contact information/Last donation is updated.