Alexandria Blood Drive Registration- May 8, 2012

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Online registration is not required but recommended. Please fill out the following information to help us prepare for this event. You may contact Dorothy Fuchs, school nurse at fuchs@alexandriaschools.org or 908-996-6811 with questions or concerns. Please refer to this website to find out if you can donate: http://nybloodcenter.org/donate-blood-faq.do?sid0=61&page_id=165.

First Name of Donor *

Last Name of Donor *

Phone Number *

Please include area code and hyphens: 908-555-1212. We may need to contact you about your requested appointment.

Email address

We may need to email you about your requested appointment & to send a reminder.

Appointment Times *

Please choose a time you would like to donate blood. The entire process takes about an hour. You will be contacted if your requested time is full. (Full slots will be removed from this form ASAP.)

4:15

4:45

5:00

5:15

5:30

5:45

6:15

6:30

6:45

7:00

7:15

7:30

7:45

8:00

8:15

Will you require babysitting services?

This will help us plan for volunteers.

Yes

Maybe

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This form was created inside of Alexandria Township School District.