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Blood Drive Donations, 2024
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* Indicates required question
Tower Name
*
Your answer
Real Life Name
*
Your answer
Rank
*
Choose
Citizen or Resident Citizen
Novice or Recruit
Accepted or Soldier
Aes Sedai
Gaidin
Affiliation
*
Choose
No Affiliation
Blue Ajah
Brown Ajah
Gray Ajah
Green Ajah
Red Ajah
White Ajah
Yellow Ajah
Dai M'Hael
Mahdi'in d'ma Dieb
San d'ma Shadar
Val'Cueran
Date of Donation
*
MM
/
DD
/
YYYY
Geographic Location of Donation
*
Your answer
What form of blood did you donate?
Whole Blood
Double Blood
Platelets
Plasma
Other:
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If you supported the Tar Valon Blood Drive in a different way, please describe:
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Which organization did you donate to?
Your answer
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