Cashback Card
Karty Cashback Krwiodawcy
Email address *
Rodzaj karty ( type of card ) *
Dodatkowe informacje ( additional information ) *
Your answer
Nazwisko i Imię ( surname, name) *
Your answer
Grupa krwi ( blood group ) *
Telefon ( phone ) *
Your answer
E-mail ( mail ) *
Your answer
Kraj ( country ) *
Your answer
Województwo ( province ) *
A copy of your responses will be emailed to the address you provided.
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