Name: Gender: MaleFemaleTransgender Mobile: Email: Age: City: State: —Please choose an option—Andhra PradeshAmaravatiArunachal PradeshAssamBiharChhattisgarhGoaGujaratHaryanaHimachal PradeshJammu and KashmirJharkhandKarnatakaKeralaMadhya PradeshMaharashtraManipurMeghalayaMizoramNagalandOdishaPunjabRajasthanSikkimTamil NaduTelanganaTripuraUttar PradeshUttarakhandWest BengalAndaman and Nicobar Islands (UT)Chandigarh (UT)Dadra and Nagar Haveli (UT)Daman and Diu (UT)Delhi (UT)Lakshadweep (UT)Puducherry (UT) PinCode: Blood Group: A+A-B+B-O+O-AB+AB- Health Issues (if any): YesNo Please tick below to submit the form: I agree to donate blood at the Blood donation camp in my locality on 6th Dec 2024. I confirm all the information given here are correct/मैं पुष्टि करता हूं कि यहां दी गई सभी जानकारी सही है
