Username already exist"); }else{ $sql = "insert into users (fname, ddob, mdob, ydob, bloodgroup, mobile, dayphone, evephone, chkSMS, state, city, town, how_often, username, ipassword, gender, weight, email, dlast, mlast, ylast, chkHideMobile, suffered1 ) values ('$fname', '$ddob', '$mdob', '$ydob', '$bloodgroup', '$mobile', '$dayphone', '$evephone', '$chkSMS', '$state', '$city', '$town', '$how_often', '$username', '$ipassword', '$gender', '$weight', '$email', '$dlast', '$mlast', '$ylast', '$chkHideMobile', '$suffered1')"; $results = mysql_query($sql) or die(mysql_error()); $adminemailid = "info@biharbloodbank.in"; $to = $email; $subject = "biharbloodbank.in Registration"; $message = "
Biharbloodbank.in is not any commercial website for blood sale or purchase, its a web based free medium between donor and needy person.

Important : All Voluntary Donors are warned of likely misuse of blood donated by them at the hospital with or without the knowledge of the hospital management. We have come to know of such misuse at various towns and cities. Biharbloodbank.com requests all donors to take a little extra care by verifying the genuine need by contacting the patient's relatives and doctors. At some places the hospital staff have taken the blood and sold it to others for a price. As a responsible citizen/donor we request you to keep a watch on such people and hospitals. There is a severe shortage of safe blood and voluntary donors. Donors must inform the Biharbloodbank.com team members/coordinators of such areas in case of any doubt.

If you want any perssonal assitance in blood donation then kindlycontact Mr. Mukesh Hissariya - +91-9308393446

"; $headers = "MIME-Version: 1.0" . "\r\n"; $headers .= "Content-type:text/html;charset=iso-8859-1" . "\r\n"; $headers .= "From: ".$adminemailid." <".$adminemailid.">\r\n"; $headers .= 'To: '.$to.' <'.$to.'>'."\r\n"; //$headers .= 'Bcc: \r\n'; //exit; $mailit = mail($to,$subject,$message,$headers); if ( $mailit ) { $msg .= "
Mail sent successfully
"; }else{ $msg .= "
Mail could not be sent this time try again.
"; } $message = "Name: " . $fname . "
". "DOB: " . $ddob . "-".$mdob."-".$ydob."
". "Blood group: " . $bloodgroup . "
". "Mobile: " . $mobile . "
". "Day Phone: " . $dayphone . "
". "Evening Phone: " . $evephone . "
". "check SMS: " . $chkSMS . "
". "state: " . $state . "
". "city: " . $city . "
". "town: " . $town . "
". "How often: " . $how_often . "
". "Gender: " . $gender . "
". "weight: " . $weight . "
". "email: " . $email . "
". "Username: " . $username . "
". "Last donated: " . $dlast . "-" . $mlast . "-" . $ylast . "
"; $headers = "MIME-Version: 1.0" . "\r\n"; $headers .= "Content-type:text/html;charset=iso-8859-1" . "\r\n"; $headers .= "From: ".$adminemailid." <".$adminemailid.">\r\n"; $headers .= 'To: '.$adminemailid.' <'.$adminemailid.'>'."\r\n"; $mailit = mail($adminemailid,$subject,$message,$headers); } header("location:registration.php?msg=
Record submitted successfully
".$msg); } ?> Bihar Blood Bank

Registration

* Mark fields are mandatory
Name* :
Password*:

Minimum 4 characters allowed
Date of Birth*:
(min: 18 yrs max: 55 yrs)

Date of birth will not be shown to others. It's only for calculating your age.
Blood Group*
Contact Number :
Mobile*:

Residence:

Office:

Note: Please provide at least one contact number. But it is recommended to provide as many contact numbers as possible because it will be easier for the recipients to contact you in times of emergency. Remember a life may be depending on you!

SMS Alert :
You will receive an alert on your mobile when there is a request for your blood type within your city.
State*:
City*:
Area*:
How often have you donated blood in the past?
Username*:

(min 6 characters) Check Availability?
Confirm Password*:

Please re-enter your password
Gender* :
Female
Male
Weight*:
 Kgs
(should be above 50 kg)
E-mail*:

We recommend you enter the e-mail ID, which will help us get in touch with you in case you are not reachable by phone. It will be greater help if you could provide us your personal e-mail ID besides your corporate e-mail ID. You can always be reached to save a life!
Date of last blood donation :

(optional)
Hide Mobile Number:

Please check your eligibility to donate blood

# Please consult your physician to check for eligibility.
I have read the above eligibility criteria and confirm that I am eligible to donate blood.
I authorise the website to display my telephone number, e-mail ID and mailing address so that the needy could contact me, as and when there is an emergency.