ひろしま骨髄バンク支援連絡会
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If you want to register as a volunteer donor, please full in the form below and push transmission button.

I want to register as a volunteer donor.
I satisfy the following three qualifications.

  1. I fully understand the implications of bone marrow donation.
  2. I have obtained the consent of family.
  3. I am in good health and do not fall into the category of disqualified persons listed at the end of this brochure.
I want to take the blood test at the Data Center in
prefecture :
(Please write the names of the city and prefecture.)

Postal code :
Address :
Name :
Sex : Male　Female
Date of Birth : //　Age :
Telephone No. :
E-Mail :

　

　

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For inquiries and further information, contact:
Hiroshima Marrow Donor Support Federation
MK Building 4 F 5-10-401 3-chome, Senda-machi, Naka-ku, Hiroshima 730 Japan
Phone and Fax 81-82-504-4362