[KANAA] Blood Donation Camp - Jan 2015

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Blood Donation Camp - Jan 2015

Kanaa Charitable Trust is organizing its 6th Blood Donation drive on behalf of 66th Republic day of India.

* Required

Kanaa 6th Blood Donation Drive


Name *
Enter your name
Age
Enter your age
Sex *
• Male
• Female
Blood Group
e.g. A+ve, O-ve
A1 Negative (A1 -ve) A1 Positive (A1 +ve) A1B Negative (A1B -ve) A1B Positive (A1B +ve) A2 Negative (A2 -ve) A2 Positive (A2 +ve) A2B Negative (A2B -ve) A2B Positive (A2B +ve) B Negative (B -ve) B Positive (B +ve) B1 Positive (B1 +ve) O Negative (O -ve) O Positive (O +ve)
Mobile Number *
Enter your mobile number
E-Mail ID *
Enter your e-mail id
Are you interested to donate blood regularly?
Yes No

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