SAMAR - Bring a smile back to life
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The chances of finding a matched donor have improved recently, but many are still in the search process awaiting a donor.

Registering a large number of donors from the same race increases the chance of a patient finding a life saving marrow match.

Educating and informing donors is an important factor in retention.

Together, we can HELP
BRING A SMILE BACK
TO LIFE.

drive request from

SAMAR needs minimum FIVE BUSINESS DAYS notice to be able to comply with your request to setup a drive.

* = required fields
Have you read over the Drive Instructions No Yes
First Name*
Last Name*
E-mail address*
Phone number*
Address*
No PO Box numbers
Alternate Name
Alternate Phone Number
Date of Drive / / 20
Time of Drive to
Event Name
Event Host Organization
Address of Drive
Is this drive patient focused No Yes
If yes, Patient Name
Number of people expected at event
Number of kits requested

(Please remember that not everyone can register and many people have already registered. Please leave blank if unsure
and we will contact you to discuss)
Setting

If other, please specify
Verfication code*
 

Please Return all the kits used as wells as unused by the next business day

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SAMAR Head Office
Rafiya Peerbhoy Khan
Moazzam Ali Khan
55-13 96th St., Corona, NY 11368
samar@samarinfo.org
Tel: (718) 592-0821, (718) 775-3882
Fax:(718) 592-5848
Boston Chapter
Vikramjit Chhabra

Roopjyot Kaur, PhD:
roopjyot@samarinfo.org
Tel: 508-925-4531

D.C., MD, VA Chapter
Poornima Vijayanagar
pvijayanagar@gmail.com
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