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Blood Donor Registration
Name:
Gender:
Male
Female
Date of Birth:
Weight:
Phone:
Email:
Blood Group:
A1+
A1-
A2+
A2-
B+
B-
A1B+
A1B-
A2B+
A2B-
AB+
AB-
O+
O-
A+
A-
RH+
RH-
I don not know my blood group
Last Donation:
Frequency:
yet to donate
regular donor
on need basis
Address:
Zip Code:
