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Covid-19 Response Initiative
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Covid-19 Response Initiative
Donor Registration Form
Name :
*
Residential Address :
*
Mobile No :
*
State :
*
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Andhra Pradesh
Himachal Pradesh
Jammu and Kashmir
Andaman and Nicobar
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chhattisgarh
Dadra and Nagar Haveli
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Goa
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Hydrabad
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Lakshadweep
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Telangana
TELANGANA 1
Tripura
Unknown State
Uttar Pradesh
Uttarakhand
West Bengal
District :
*
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City :
*
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Taluka :
*
Blood Group :
*
<-Select->
A RhD positive (A+)
A RhD negative (A-)
B RhD positive (B+)
B RhD negative (B-)
O RhD positive (O+)
O RhD negative (O-)
AB RhD positive (AB+)
AB RhD negative (AB-)
Any Disorder or Disability ? :
*
Yes
No
Donation Info
Donation Type:
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<-Select->
Organs
Blood
Plasma
Donation Details:
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