There are a few conditions that may prevent you from joining the registry today.

Please first view the Basic Health Screening document to see if you meet higher-level qualifications.

If you have a condition that requires further evaluation based on the Basic Health Screening document, please see the Advanced Health Screening Document and/or speak with Dan.

There is a significant problem with people joining the bone marrow registry and not following through on their commitment to continue the donation process if they’re called. This problem is significant enough that BeTheMatch has redesigned their forms to underscore the importance of the commitment.

Please consider for yourself if being on the bone marrow registry is something you can fully commit to. If you’re on the fence, we would rather you sign up at a later date than join the registry today. The stakes for many families are simply too high.

Required commitment

Must-have fields

1. You must answer YES to all questions in Step 1.
2. You must answer VERY LIKELY/LIKELY or VERY WILLING/WILLING to all questions in Step 2.

If you cannot answer “Yes” to all of Step 1 and “Very likely/Likely”, “Very willing/Willing” all of Step 2, we ask that you do not join the bone marrow registry today.

Page 2 of 6

Must-have fields

1. Full name
2. Birth Date
3. Age
4. Sex
5. Email address
6. Telephone number (Home # can be a cell phone #)
7. Current mailing address (must be US)
8. Permanent mailing address, if different from current address (must be US)
9. Are you Hispanic and/or Latino? (Do not miss this checkbox!)
10. Specified ethnic background

The first information used to contact you if you are indeed discovered to be a match.

Due to the significant need for minority donors, the specification of the donor’s ethnic origin is extremely important.

Page 3 of 6

Must-have fields

1. First contact: Full name
2. First contact: Telephone number
3. First contact: Email address
4. First contact: Language preference
5. Second contact: Full name
6. Second contact: Telephone number
7. Second contact: Email address
8. Second contact: Language preference

Be The Match requests that you provide the contact information for two people who do not live with you and do not live together. People move, change phone numbers, and change email addresses, and as a result your own contact information may not be enough to reach you when you’re found to be a match. These first and second contact people may be instrumental in locating you if you cannot be reached.

Employer and spouse information are helpful but not mandatory.

Page 4 of 6

Must-have fields

1. These fields are considered optional.

Please complete the donation history section if possible.

Page 5 of 6

Must-have fields

1. This page is informational.

This page provides important background information for joining the registry. Please read the contents carefully, and make sure you understand the commitment and your rights before signing the form.

Page 6 of 6

Must-have fields

1. Checkbox to confirm intent
2. Signature
3. Today's date
4. Printed name

The last step of the registration form is to read and understand the donor agreement. This section outlines the donor’s rights and responsibilities and must be completed to register the cheek sample.

Swabbing Instructions

1. Swallow.
2. With each provided cotton swab, swab the inside of your cheek for 10-15 seconds. It's okay to switch sides or stay on the same side of your mouth.
3. Put the swab in the slits of the foam provided. Some kits have sticky tape instead of foam slits, at which point you can simply place the swabs on the tape in the designated locations.
4. When all four swabs are placed within the kit, close it and place the swab kit back in its original envelope.
5. The wrappers that held the swabs are now garbage which can be thrown away.