Florida Blood Services

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Eligibility Info

Registration Form

Blood Drive Planner

Registration Form

Please note: All items in RED are required. Please be sure to provide a valid email address.

First Name:
Middle Initial:
Last Name:
Email Address:
Home Phone:
Cell Phone:
Address:
City:
State:
Zip Code:
High School Name:
Graduation Year:
County In Which You Live:
College You Plan To Attend:
Have You Ever Helped Organize A Blood Drive:
If Yes, Please Provide Location And Date:
Proposed Blood Drive Date:	, 2008
Please allow 3-4 weeks lead time from date of form submission.
Proposed Blood Drive Location:
Please provide proposed location name & city.

Mission Statement
To improve lives by providing quality blood services and exceptional customer service.

Vision Statement
To be a world class provider of
blood and blood services.

Quality Statement
We accept responsibility for providing quality products and services 100% of the time.