This form is to be filled by those who wish to participate in the Blood Donation Drive organized by the Social Service Foundation in Marshfield, Wisconsin from Friday, October 28, 2016 to Sunday, October 30, 2016. Participants must be at least 16 years old (with parent/guardian consent) to donate blood. If you simply wish to make a donation to the Social Service Foundation, please get in touch with the local office on 1244 Bellevue Street. Participant's Name: Male/Female
Home Address:
City, State, Zip:
Work Phone: Home Phone: Age:
E-Mail Address:
Blood Type:

Please note: If you have been suffering from certain illnesses in the recent past, you might not be allowed to donate blood. Please bring records of your latest health check-up.

Participants are also expected to make a donation of $5 to the Social Service Foundation, in exchange for which they will receive a T-shirt and a certificate for having donating blood. Please specify T-shirt size below.

T-shirt Size: Small Medium Large X-Large

(Those who do not participate in the Blood Donation Drive but donate $15 and above to the Social Service Foundation will also receive a free T-shirt. T-shirts and other Social Service Foundation items can also be purchased from the local office or by visiting the website http://www. socialservicefoundation. org.)

Please complete all information above, sign below, and submit this form to the Social Service Foundation, 1244 Bellevue Street, Marshfield, Wisconsin 45536.

I am submitting my registration to be part of the Blood Donation Drive organized by the Social Service Foundation on 28-30 October, 2016. I understand that I am expected to donate blood and make a contribution of $5 to the Social Service Foundation.
Participant's Signature:
Date:
7
Why would a person visit the website of the Social Service Foundation?
A.
to fill out the registration form
B.
to buy T-shirts and other items
C.
to specify the size of T-shirt he or she wants
D.
to donate money to the Social Service Foundation