Give Platelets Application Form

Please fill in the form below if you are interested in giving platelets.

First name:*
Last name:*
Date of birth:
Sex:*	MaleFemale
Address:
Telephone no:*
Email:*
Have you ever given blood in Ireland?:	YesNo
Donor ID (if known):

National Blood Centre, James's Street, Dublin 8. Tel: 00 353 1 4322800 Fax: 00 353 1 4322930