Donor Registration Form

  • We are very glad that you want to signup as donor.
  • To register as a blood donor is a responsibility.
  • Once you are a registered donor, implies that you will be glad or privileged to donate blood at all possible times.
We respect your privacy. We will never rent, sell or give away your email to any third party.

 * Donors Full Name
 * Gender
 * Date of Birth
 * Blood Group
   Frequency
   Last Blood Donation Date
 * Email
 * Mobile No
    Phone No
   Address
 * Country
   State
 * City
   District
 * Pin Code
Show Contact Details to Public
  Yes       No

Login Information
 * Username
 * Password
 * Retype Password

Form Verification
 * Code
I want to volunteer for the project.
I am voluntarily registering as a blood donor. I have read the eligibility criteria and confirm that I am eligible to donate blood. I authorize Save Life India to display my name, mobile/telephone number, email address and/or postal address to the person who is in need of blood. I release Save Life India, all organizers, trustees, volunteers and assistants in this project from all damages whatsoever and waive all rights to compensation in case injury or loss. I agree to receive information about Save Life India through various media including print and electronic media with a facility to opt-out.