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):

Darshana

Darshana: With lot of support from my husband and my parents, I was ready to donate my marrow. One early morning, I went to the City of Hope to have the procedure. I was given general anesthesia and a small amount of marrow was extracted from my pelvic bone. I was sent home the next day and my marrow was sent to the waiting patient--a nine-year-old girl. She is a teenager now!

Make your donations for miracle marrow matches