Convalescent Plasma Registration of Interest Form About youWhat best describes your circumstances in relation to COVID-19?*I tested positive for COVID-19 and was hospitalisedI tested positive for COVID-19, but was not hospitalisedI had symptoms of COVID-19, and self-isolatedThank you for your interestAt this time we can only accept donations from members of the public who have tested positive for COVID-19.Have you previously donated with NIBTS?*YesNoPlease enter your Donor Number if known (optional)The format of the Donor Number is R0XXXXXXAre you aged between 17 and 66 years old?*YesNoThank you for your interestUnfortunately, you can only become a blood donor between your 17th and 66th birthday. If you're a regular donor aged 66 or over and in good health, you can keep donating.Do you weigh more than 7stone 12lbs (50kg) and less than 25 stone (158kg)?*YesNoThank you for your interestUnfortunately, you must weigh more than 7stone 12lbs (50kg) and less than 25 stone (158kg) to be eligible to donate.Are you pregnant, or have you had a baby, miscarriage or a termination in the last 6 months?*YesNoThank you for your interestA period of six months must have passed before you would be eligible.Have you had a blood or blood product transfusion since 1st January 1980?*YesNoThank you for your interestUnfortunately, you're not eligible to give blood if you have received (or think you might have received) a blood transfusion since 1980.Have you got, or have you had, any heart conditions?*YesNoThank you for your interestUnfortunately, you're not eligible to give blood. Many thanks for your support. If you'd like more information, please get in touch.Your personal detailsName* First Last Date of birth (dd/mm/yyyy)*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Sex*MaleFemalePrefer not to sayEmail* Phone Number*Address* ZIP / Postal Code Consent*I consent to be contacted by NIBTS to assess my eligibility.NameThis field is for validation purposes and should be left unchanged.