Please fill the following questionnaire, to register with us as a Plasma recipient. Will be not misuse the information and only required information has been asked.You will be informed when we have a potential donor matching your requirements.

I Consent to the condition.

The information provided here is complete and correct to the best of my knowledge. I authorize to display my Name, Mobile/telephone Number,Email Address and/or postal address to the person who is willing to donate Plasma. I release 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 through various media including print and electronic media with a facility to opt-out.