Consent form for enrollment as a voluntary blood /apheresis donor

Please fill the form and press submit to get registered.
Note:It is compulsory to fill in all the fields.

NAME:
CONTACT NO:
ADDRESS
SEX Male: Female:
COMMENT
I WANT TO BE ENROLLED AS AN BLOOD DONOR AND I UNDERSTAND THAT I WILL NOT BE ENTITLED FOR ANY MONETARY OR OTHER BENEFITS.
Help line no's: 9810125104, 9810125105, 9810125106,
Postal Address: E-410, Greater Kailash, Part-2, New Delhi-48
e-mail: safblood@del3.vsnl.net.in
Pager: 9628005982
Telefax: 621 0110