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Volunteer Member Need Blood

Volunteer Member Internship Need Blood

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+91 9823923846

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Our Team

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Our Team

Our expert team

Syed Taher Hussain

Syed Taher Hussain

Founder

Prof Ch Rekha Rao

Prof Ch Rekha Rao

Chief Patron

At our NGO, we believe in the power of collective action to create lasting change. Our team is made

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visionagape@gmail.com
+91- 9823923846

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Donate Blood

Full Name *

Date of Birth *

Mobile Number *

Email *

Select Blood Group *

Weight *

Last time donated blood date *

Have you ever been deferred or rejected as a donor *

Current Living City *

Address *

Any medical conditions or allergies *

Any medication that you are currently taking *

How did you hear about AGAPE's blood donation drive *

By submitting this form, I declare that I am in good health and am willing to donate blood voluntarily in case of a medical emergency or as required by AGAPE. I understand that AGAPE will use my personal information only for the purpose of blood donation and will keep my information confidential.

Need Blood

Patient Name *

Patient Dob *

Attendee Name *

Attendee Mobile Number *

Select Blood Group *

Select Blood Component *

Required Date *

Units *

Location For Donation *

Requisition Form From Doctor ( Image) *

Refer By ( If any ) *

Support Ticket

Title Name *

Subject *

Email *

Priority *

Issues *

Description *

visionagape@gmail.com
+91 9823923846

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