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testing
Register as Blood Donar
Dear Donors,
Please fill the following information to register.
*
= required
Name:
*
Blood Group:
*
Please select:
A +ve
A -ve
AB +ve
AB -ve
B +ve
B -ve
Dont know
O +ve
O -ve
Sex:
Male
Female
Date of Birth:
*
Contact Information
Mobile Number:
*
(Ex:+919885123456)
Other Number:
(Ex:04024444444)
State:
Andra Pradesh
Arunachal Pradesh
Assam
Bihar
Chhattisgarh
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu and Kashmir
Jharkhand
Karnataka
Kerala
Madya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Orissa
Punjab
Rajasthan
Sikkim
Tamil Nadu
Tripura
Uttaranchal
Uttar Pradesh
West Bengal
City:
*
E-mail:
Date of Last Donation:
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