Blood Drive Request Form

Ready to host a blood drive?

Fill out the form below and one of our territory representatives will reach out to you.

Full Name(Required)

First Name Last Name

Email(Required)

Phone(Required)

Organization Name

Full Address(Required)

Potential Blood Drive Location (if unknown, please use most likely City, State and Zip Code)

Street Address City State ZIP Code

Has your organization previously hosted a blood drive with Central California Blood Center?(Required)

Yes

No

How many people are in your organization/community?(Required)

How many are interested in donating blood?(Required)

Anything additional you would like to share or ask?