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E-mail: admin@safehandsfoundation.org

Blood Donor Enrollment Sheet

Read the points given below carefully before filling the details. You may email us to make enquiry or for any other assistance. Contact Us.
Full Name: *
Blood Group: *
Gender: *
Date of Birth: *
Country: *
State: *
District: *
Phone: *
Email ID: *
Are you OK to share your Contact Details openly on our Website?: ##
Prev. Date of Blood Donation: (Optional)
Task: *
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  • * - Mandatory Fields. Please enter correct details for proper processing of your Donation.
  • ## This option helps the patients in Emergency. If you select YES, your contact details will be available on our website to the Requestor of Blood.
  • If Register button is disabled, the possible reason could be javascript is not enabled in your brower. Please enable it to use this feature or send all your details in above format of the form through an email to us to place a request. Contact Us.