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Blood Donor Registration
Full Name
Information you provide will remain confidential and will not be used for any marketing purpose.
Access to this information is limited to staff with a genuine and essential need to have such access and will not be available to offenders or other persons.
Gender
Male
Female
Blood Group
A +ve
A -ve
B +ve
B -ve
AB +ve
AB -ve
O +ve
O -ve
Contact Details
Kindly update your date of donation once done.
Also please update your profile/information if in case you relocate in future.
Ask your friend or relative to be a volunteer donor, He / She would have Saved a life.
Email Address
Note : Email Address will provide you
the Login Access to your account to update personal details.
Mobile Number
Area
--Select--
Mannagudda
Kankanadi
Kapikad
Lalbhag
Bejai
jyothi
Nanthoor
Kadri
Adyar
Any
Urwa
surathkal
PVS
Statebank
Thokkotu
padil
kodikal
Mangaladevi
KASARAGOD
Pumpwell
I hereby declare that the particulars furnished above are true and correct, and I am willing to Donate Blood on request.
You must select this box to proceed.