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Blood Donor's Profile
Please fill up the form below as directed if you want to save a life.Your information will not be shared in any other purpose.
Joining
www.facebook.com/communityactionbd
&
www.facebook.com/groups/communityactionbd
will help us to communicate with you.
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* Indicates required question
Name
*
Please provide your full name.
Your answer
DOB
*
mm/dd/yy
Your answer
Gender:
*
Male
Female
Weight:
*
In Kg's
Your answer
Blood Group:
*
Must be recently checked
A (+ve)
A (-ve)
B (+ve)
B (-ve)
O (+ve)
O (-ve)
AB (+ve)
AB (-ve)
Home Adress/Area:
*
Your answer
Institution/Company/Office:
*
Your answer
Contact Number:
*
Please provide your active number and add ''+'' in front of ''0'', e.g. +01XXXXXXXXX
Your answer
Email ID:
*
Double check your email id, we will contact with you through that.
Your answer
Facebook URL:
*
e.g.
http://www.facebook.com/hasan.akash
( you can get your FB URL by checking your info in FB profile)
Your answer
Do you have any contagious or blood related diseases?
*
Answer is case sensitive, please provide carefully.
No
No, But had before
Yes
Other:
When have you donated your blood last? If not then write "NO''.
*
e.g. 3 months 15 days.
Your answer
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