February 19th Blood Drive Appointments

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Please fill out the info below! The blood drive is on February 19th. Thank you for doing your part and saving lives!

First name *

Last name *

Phone Number *

Appointment Time (11 am - 5 pm) *

11-11:30

11:30-12

12-1:30

1:30-2

2-2:30

2:30-3

3-3:30

3:30-4

4-5

Are you donating double red? *Double Red allows you to safely donate two units of red blood cells during one donation while returning your plasma and platelets to you. Double Red is blood type specific and for donors who are larger in stature and heavier in weight.* *

Yes

Date of Birth (mm-dd-yyyy) *

Blood Type (Optional)

Did anyone recruit you? List name if so

Submit

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