Red Cross Rizal Chapter Pep Talk and Blood Donation Drive

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Full Name* This field is required.
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Date of Birth* This field is required.
Month
Day
Year
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BLOOD GROUP* This field is required.If you are not familiar yet, please choose 'Not Yet Familiar'.
Please Select
Please Select
A+
A-
B+
B-
O+
O-
AB+
AB-
Not Yet Familiar
4
Last Blood Donation DateIf this is your first time or you can't recall the last time you donated, you may skip this part and click 'Next'.
Month
Day
Year
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Mobile Number* This field is required.
6
Email* This field is required.
example@example.com
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Preferred Schedule* This field is required.To ensure compliance with health protocols, we recommend that you only drop by on your chosen schedule. We will contact you separately if we need to move you to the next available schedule. Walk-ins may only be accommodated if there are still available slots at the time of their visit. Don't forget to wear your face mask and face shield.
February 20, 2021 - 10AM - 11AM [FULL as of 02/16/2021]
February 20, 2021 - 11AM - 12NN [FULL as of 02/16/2021]
February 20, 2021 - 12NN - 1PM
February 20, 2021 - 1PM - 2PM
February 20, 2021 - 2PM - 3PM
February 20, 2021 - 3PM - 4PM
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Affiliation* This field is required.If you were referred to or invited by any of our partner organizations, kindly indicate them below. You may choose multiple answers.
Alpha Phi Omega
Barangay San Antonio
JCI Ortigas
Philippine Red Cross
Pru Life UK
Walang Maiiwan PH
Walk-in
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Are you a Jaycee? Kindly indicate your JCI chapter below. If not, kindly indicate N/A* This field is required.
10
By signing this form, you agree to share your details with the following organizations. Rest assured that we will process your personal information with the utmost care and in compliance with the Data Privacy Act of 2012 and applicable laws.* This field is required.
JCI Ortigas
Pru Life UK
Philippine Red Cross
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