Platelet Donor Form
Hello and thank you so much for helping to save some freaking lives! You are an amazing person and you should just know that. With your basic information below, we do ask that you participate by also submitting the following: Selfie during donation, and the Name of the donation site If no selfie, then please provide: Appt date and time Physical address of site contact info of donation site

UPDATE: Only shirt sizes remaining for this particular campaign are XL,XXL and XXXL

This is so we can send you an awesome Hemp T-shirt!
(Optional if selfie at location is included)
(Optional if selfie is included)
We are tracking sources for a friendly competition. Please try to remember exactly how/where you heard about the initiative so they get credit
(Not required and will not be shared publicly, but would be helpful for us to tune in our messaging!)
Click or drag files to this area to upload. You can upload up to 2 files.
Please upload your donation selfie(s) (if applicable)