menu

Your Personal Information

Legal Consent and Signature

Lifesaving starts here. We can only register you if you provide ALL the details below.
Please read and complete the information below to indicate your consent.
Thank you for your time and providing your information. Now please review to ensure all your information is correct.
  1. Basic information
  2. What is your ancestry?
    • In most cases, patients match with donors who share the same ancestry and/or ethnicity. Knowing your background can enhance a patient's donor searches. If you are not sure of your heritage, think about where your grandparents or great-grandparents came from originally.
  3. Alternate Contact Information
    • Please provide contact information for a close friend or relative other than yourself who will know how to reach you if you become a match in the future. This person will be contacted only if we cannot reach you using the contact information you provided above.
  4. DISCLOSURE - NEWSLETTER AND INFORMATION
    • As a potential donor you will receive regular newsletters, medical information, process-related updates and general information about DKMS US.

      If you don`t want to receive further e-mails, you can unsubscribe by sending an e-mail to nonews@dkms.org with the subject "NONEWS”

      I consent to receiving one or more automated texts at the cell phone number provided from or on behalf of DKMS. Frequency will vary. Message & Data rates may apply. Text STOP ALL to cancel.

  5. Your information
    •  
  6. Alternate Contact Information
    •  
* Mandatory Fields