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Registration form
Blood Registration Form
Name of the donor
Blood Group
A POSITIVE (A+)
A NEGATIVE (A-)
B POSITIVE (B+)
B NEGATIVE (B-)
AB POSITIVE (AB+)
AB NEGATIVE (AB-)
O POSITIVE (O+)
O NEGATIVE (O-)
A1 POSITIVE (A1+)
A1 NEGATIVE (A1-)
B1 POSITIVE (B1+)
B1 NEGATIVE (B1-)
A2 POSITIVE (A2+)
A2 NEGATIVE (A2-)
A2B POSITIVE (A2B+)
Contact Number
Date of Birth
Gender
Male
Female
Transgender
Already Blood Donor
Yes
No
Address
Pin Code
Previous Blood Donation Date
Options for blood donation
Once in 3 Months
Once in 6 Months
Once in a Year
Preferred Reminder Service
By Whatsapp
By SMS
By Email
Have you Vaccinated for covid 19
Yes
No
Vaccinated Date (Approximate)
Reference Name
Reference Contact Number