Change address form *Required fields Greeting: Mr. Ms. *First name: *Family name: *Date of birth: Email address: Donor number: New address: *Effective date: *No.: *Street: Apt.: *City: *Province: *Postal code: *Telephone (home): Telephone (work): Cell. phone: In order for us to notify our respective teams of your change of address, please let us know if you are registered: * As a blood donor at Héma-Québec yes no * With the Héma-Québec Stem Cell Donor Registry yes no * With the Héma-Québec Public Cord Blood Bank yes no * With the Héma-Québec Public Mothers' Milk Bank yes no
