Order an Individual Kit

Home Kit Questions

Fill out the form below if you would like a home kit to register to be a marrow/stem cell donor with the National Marrow Donor Program Registry.
*home registration kits are free for anyone of all or part ethnic minority descent (all or part Asian and Pacific Islander, Hispanic/Latino, African American/Black or Native American/Alaska Native)

1) Are you all or part ethnic minority? (Asian/Pacific Islander, Hispanic/Latino, Black/African American, Native American/Alaska Native or multi-racial)	Yes No

2) Are you between 18-60 years old?	Yes

3) Have you ever had any neck, back, hip or spine problems?	Yes No	If yes, please describe in as much detail as possible: Answering yes does not necessarily disqualify you from registering.

4) Have you ever had any personal history of Asthma, Cancer, Diabetes, Hepatitis, or Heart Problems?	Yes No	If yes, please describe in as much detail as possible: Answering yes does not necessarily disqualify you from registering.
Please note that sending out home kits are a large expense for A3M, which is a non-profit organization. Please make your request for a home kit only if you are certain that you would like to register. If you need additional information or have any questions, please contact our office by phone or email before requesting a home kit.

Registration

First Name:
Last Name:
Email:
Phone Number:
Street Address:
City:
State:
Zip:
Number of Kit(s):

Anne

Anne registered in May of 2001. Five years later she received a call from the donor center informing her that she was a match. She said, “ It was really nice to know that I could possibly be able to help someone who is trying to survive”. Anne said as a potential donor, she answered the health history questionnaire and gave some blood to test before the actual donation. She said, “I never had any hesitation. If I had, I would not have registered in the first place. I think it is only fair to the patient, once you make that commitment to go ahead with the process if you are called”.

When people ask her about her donation she says, “It doesn’t matter. It was never about me, it was about that person who needed my help”.

Anne’s patient is doing well. She hopes to meet him some day.

Make your donations for miracle marrow matches