I, join Blood 4 Life by agreeing to donate blood or blood products at least once per quarter. A blood center representative may contact me via my preferred method about the Blood 4 Life program to help save lives.

Signed: Date:

 
A representative from the blood center may contact me via:
PREFERED METHOD OF CONTACT
PHONE
MAIL
EMAIL
OTHER
 
Please let us know if there is someone you would like for us to contact on your behalf to inform them about the Blood 4 Life program.