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PLEDGE FORM
"30 minutes of your time and 350 ml of your Blood can make a difference between Life and Death. Gift Life, Donate Blood. Wanted: More Life Savers."
Donor Details:
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* Indicates required question
Name:
*
Your answer
Date of Birth:
*
MM
/
DD
/
YYYY
Age:
*
Your answer
Sex:
*
Male
Female
Blood Group
*
Choose
A+
A-
B+
B-
O+
O-
AB+
AB-
Mobile no.
*
(enter 10digit Mobile no.)
Your answer
Email Id:
Your answer
Category:
*
Society Member
Teaching Staff
Non-Teaching Staff
Student
Alumnus
Other
If Student:
UID No.
Your answer
Address:
*
Your answer
Pin Code:
*
Your answer
Have you donated Blood previously?
*
Yes
No
How many times?
Your answer
When last Donated?
Your answer
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