Agomoni Blood Donation 2022 – Interest Form

Agomoni is organising a Blood Donation camp on 12th Nov 2022, at San Ramon Regional Medical Center. We appeal you to volunteer in donating blood and make this initiative a success!

Please fill in this form if you are interested. (It will take less than a minute! ) 
[Note: CDC follows the FDA guidelines on accepting/deferring donors who have resided or travelled to any Malaria-endemic countries. Unfortunately, most part of India fall into the malaria-transmission risk area, as per CDC.
Herein, we are collecting some travel related information, so that you will be better informed about the eligibility before you register with our blood drive partner Vitalant. ]
(Please fill in the same form separately for any other adult family members, who might be interested in donation too.)

We will reach out to you soon with more details to register with our drive partner Vitalant. Thank you! for your time to provide the information