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Blood Drive Donations, 2021
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* Indicates required question
Tower Name
*
Your answer
Real Life Name
*
Your answer
Rank
*
Choose
Citizen or Resident Citizen
Novice or Recruit
Accepted or Soldier
Aes Sedai
Gaidin
Affiliation
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Choose
No Affiliation
Blue Ajah
Brown Ajah
Gray Ajah
Green Ajah
Red Ajah
White Ajah
Yellow Ajah
Dai M'Hael
Mahdi'in d'ma Dieb
San d'ma Shadar
Val'Cueran
Date of Donation
*
MM
/
DD
/
YYYY
Location of Donation
*
Your answer
Which organization did you donate to?
*
Your answer
Was this a double donation?
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