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or
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Donor's card
Application - “Limited Edition”
Application - “Limited Edition”
This application is reserved for activation code holders.
All fields marked with
*
are required.
Contact information
Title
Name
*
Surname
*
Date of birth
*
Street
*
ZIP
*
City
*
Region
---------
Banskobystrický kraj
Bratislavský kraj
Košický kraj
Nitriansky kraj
Prešovský kraj
Trenčiansky kraj
Trnavský kraj
Žilinský kraj
Country
*
Phone
E-mail
*
How did you hear about the donor card?
Consent to the processing of personal data
I agree to manage,
process and store personal data for the Donor Card
Helicopter Emergency Medical Service program.
*
Activation code
Code
*
Enter the exact code. Keep capital and small letters.
Send