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Blood Donation Requirement
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* Indicates required question
Your Name
*
The one who is requesting for the blood.
Your answer
BTC Membership ID
Its an optional field, just for the records.
Your answer
Contact Person Name
*
Whom should donor get in touch with
Your answer
Contact Person Phone Number
*
Your answer
Blood Group Required
*
Requested blood group
Choose
A+ve
A-ve
B+ve
B-ve
AB+ve
AB-ve
O+ve
O-ve
Any
Number of Units
*
Your answer
Requirement should be fulfilled by?
Its an optional field, fill only if you know
MM
/
DD
/
YYYY
Hospital Name and Address
*
It would be nice if you provide google map link too.
Your answer
Reason of Blood Requirement
Fill only if you know the reason.
Your answer
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