Become a Donor

State* AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY

Birthday (MM/DD/YYYY)*:

January February March April May June July August September October November December 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1992 1991 1990 1989 1988 1987 1986 1985 1984

Natural hair color*:

- None - Blonde Brown Light Brown Black Red Auburn Strawberry-blonde

Hair type*:

- None - curly wavy straight other

Eye color*:

- None - blue green brown hazel

Race*:

- None - African American Indian Chinese Japanese Caucasian Hispanic Middle Eastern Pacific Islander Other

Ethnicity*:

- None -AfricanAsianJewishMiddle EasternNorthern EuropeanSouthern EuropeanOther

Skin type*:

- None -fairmediumdarkother

Religious background*:

- None -BuddhistChristianHinduJewishMuslimOther

Marital status*:

- None -Single (no partner)Single (with partner)MarriedSeparatedDivorced

Have you previously been a donor?*:

- None -YesNo

Do you have any post high school education?*:

- None -Currently in trade school Completed trade schoolCurrently in community collegeCompleted community collegeCurrently enrolled at 4-year college univeristyCompleted BA/BS DegreeCurrently enrolled in graduate programCompleted graduate degreeOther

Current job/occupation*

How did you hear about us?*:

- None -craigslisttelevision adradio admyspacefacebookgoogle adgoogle searchyahoo searchtwitterWillamette WeekMercurycollege newspaperfriendphysicianother

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