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What is your gender?
 
Male
 
Female
 
 
 
What encourages you to be a blood donor? Check all that apply.
 
I like to help people
 
It makes me feel good
 
I have needed blood in the past and feel I should donate
 
I want to make a differance
 
Other
 

 
 
 
How often do you donate blood annually? (You can give every 56 days!)
 
None
 
1-3
 
4-6
 
7-9
 
10+
 
 
 
What is your blood type?
 
A
 
B
 
AB
 
O
 
Other
 

 
 
 
At what donation center do you donate the most blood at?
 
Community Blood Center
 
Red Cross
 
Hoxworth
 
Indiana Blood Center
 
Other
 
 
 
 
What location do you feel is the most convenient for you to donate blood?
 
At the Center, located downtown Dayton
 
At a mobile blood drive
 
At a blood drive for a school function
 
At a hospital
 
Other
 

 
 
 
In what part of the greater Dayton area do you live?
 
North Dayton(Huber Heights area)
 
Beavercreek, Xenia area
 
Centerville, Bellbrook, Sugarcreek area
 
Dayton, Riverside, Belmont area
 
Other
 
 
 
 
What is your annual income?
 
Less than $20,000
 
$20,001-$30,000
 
$30,001-$50,000
 
$50,001-$75,000
 
$75,001+
 
 
 
What would motivate you to donate blood more often?
 
I just love to help others
 
Prizes
 
Money
 
Recognition
 
Other
 

 
 
 
How did you hear about the Community Blood Center?
 
Friends/Family
 
Newspaper Ad
 
Internet
 
Doctor/Hospital
 
Other
 

 
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