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Old Age Home
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BLOOD DONATION DRIVE
Date of Birth
Are you willing to be conatcted when we conduct our Blood Donation Drive?
Have you donated blood in the last 6 months?
Do you have any kind of ailments?
Do you have any of the following?
I have been operated on
I am allergic
I had a tatoos / piercings done in last 6 months
I have engaged in "at risk" sexual activity
Fit as a Fiddle
I declare that the info I’ve provided is accurate & complete
Thanks for submitting!
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