Partners for Life Multiple Member Registration Form

Please use the following form to enter multiple members into the Partners for Life program.

  1. Complete the form. Be sure to include all the required fields.


  2. Click “Submit and proceed to next entry” to add the member to the program and to reset the form for a new entry. The “Partner ID” will be automatically filled in for you.


  3. Once all members have been entered, click “Finish”.
    NOTE: You may add members to another partner by changing the “Partner ID”.

(*) indicates a required field. SSL

Personal Information

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Partner ID#:*  Help
First Name:*
Last Name:*
Home Phone:* - -
Postal Code:*
E-mail Address:
Confirm E-mail:
Date of Birth:*

- - Help

Is the registrant an employee or member of this Organization?*  Yes No
Have they donated blood before?*  Yes No
Unless advised otherwise, the registrant's name and email address will be shared with the organization they are registering on behalf of. This will enable your organization to provide them with program updates and information regarding opportunities to donate and to track membership in the program.
Please do not share the registrant’s name and email address with the organization that they are registering on behalf of.
The registrant would like to receive information about other Canadian Blood Services programs and initiatives.
  
 
If you have questions regarding whether or not you are eligible to donate blood, please contact Canadian Blood Services at 1 888 2 DONATE (1-888-236-6283).
Privacy Statement: Canadian Blood Services respects your privacy and will not sell, rent or share your information with others. Please read our Privacy Policy.
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