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Blood Donor Name

Gender MaleFemaleOther

Phone Number

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Blood Group Select a blood groupA+ (A Positive)A- (A Negative)B+ (B Positive)B- (B Negative)AB+ (AB Positive)AB- (AB Negative)O+ (O Positive)O- (O Negative)

Blood Status Blood StatusRegular & Ready To Blood Donate - নিয়মিত এবং প্রস্তুতIrregular but Interested - অনিয়মিত কিন্তু আগ্রহী

Birthday Date  

Blood Donation Last Date  

Address

Total Blood Donation Time   0 Time1st2nd3rd4th5th6th7th8th9th10th11th12th13th14th15th16th17th18th19th20th20+