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MANAVIKATA
Blood Donor Registration Form
( EMERGENCY BLOOD BANK )
A.D Nagar, Agartala. M: 7085050209
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* Indicates required question
*Your Name
*
Your answer
*Address
*
Your answer
*Blood Group
*
Choose
A+
A-
B+
B-
O+
O-
AB+
AB-
*Contact No
*
Your answer
*Additional Contact No
Your answer
Do you ever gave blood before?
*
Yes
No
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