UNA DULCE DONACIÓN DE VIDA
Registro de donación.
Nombre
Su nombre
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Fecha de nacimiento:
Fecha de nacimiento:
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Celular/WhatsApp
Invalid phonenumber!
Invalid phonenumber!
Ha donado?
Si
No
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email: {email}<br /> user_email: {user_email}<br />
email: {email}<br /> user_email: {user_email}<br />
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Apellido Paterno
Apellido Paterno
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Tipo Sangre
Tipo Sangre
A+
A-
B+
B-
AB+
AB-
O+
O-
No Sabe
Tipo Sangre
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Email:
Email
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Seleccione área o departamento:
- seleccione una opción -
Mazapán
Caramelo
Administrativo
Familiar o amigo
- seleccione una opción -
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Apellido Materno:
Apellido Materno:
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Sexo
H
M
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Confirma tu email
Email
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Acepto Aviso de Privacidad y Términos y Condiciones.
Acepto
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Registrar
