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Continue the Commitment

Share Your Story

Fields marked with an asterisk (*) are required.

• First Name:
• Last Name:
• Daytime Phone:
• E-Mail Address:
• Donor ID#:
• Date of Birth: Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907
• Blood Type A+ A- B+ B- AB+ AB- O+ O-
• Gender Male Female
• Ethnicity Please Select... African American Asian Pacific Islander Biracial/Multiracial Caucasian Hispanic/Latino Native American
• When did you start giving blood?
• Why did you start giving blood?
• Have you or anyone in your family received blood? Yes No
• If Yes, please describe
• What does Commit for Life mean to you?
• Where do you donate? Neighborhood Donor Center Group
• Name of Group or Neighborhood Donor Center

The Blood Center is in need of more individuals who would like to share their stories.

• Would you be willing to publicly share your story? Yes No
• If so, are you fluent in Spanish? Yes No
• Would you be willing to publicly share your story in Spanish? Yes No

 

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