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ll SGM Selangor Culture Centre Blood Donation ll Kempen Derma Darah Pusat Kebudayaan SGM Cawangan Selangor ll SGM 雪兰莪文化会馆捐血运动 ll
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Name l Nama l 姓名 (as per I/C )
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Contact number l No. Telefon l 联络号码
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Age l Umur l 年龄
Your answer
Gender l Jantina l 性别
Male l Lelaki l 男
Female l Perempuan l 女
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Your preferred session to donate blood l Sesi pilihan anda untuk menderma darah l 您选择捐血的时段:-
9.00am to 10.30am
10.30am to 12.00pm
12.00pm to 1.30pm
1.30pm to 3.00pm
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Have you donated blood before ? l Adakah anda pernah menderma darah? l 您曾经捐过血吗？
Yes l Ya l 有
No l Tidak l 没有
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Remarks (any medication)l Catatan (sebarang ubat-ubatan digunakan) l 备注 （服食任何药物）)
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