Tell Us Your Story

Tell us your story.

Local lives depend on donors like you as the only source of life-saving blood products. We want to hear why you donate as it can motivate others to donate too. Not a donor? Don’t worry, we want to hear your story too. If you, a family member, or friend received blood, we want to hear how blood donation has changed your life. Please submit the form below and help inspire others to give.

Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
I am a (check all that apply):
- Blood Donor
- Plasma Donor
- Recipient of blood, plasma or other blood products.
- Family member or friend of a recipient
- Volunteer
- Other
Tell us your story
Upload a photo
Accepted file types: jpg, gif, png, Max. file size: 20 MB.
Upload a photo related to your story. (Images should be .jpg, .gif, or .png with a max file size of 20MB).
Consent*
I confirm the terms below.
I hereby grant permission for the Rock River Valley Blood Center to use my name and the information I have submitted in this form in donor recruitment materials, on the organization's website and social media pages, and in advertising and marketing collateral.
Email
This field is for validation purposes and should be left unchanged.