BloodPortal
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User Access Request Form
Your personal details are read only and have been forwarded from your BloodPortal account. If these are not correct please update your BloodPortal account before submitting this access request form.
Title:
Given Name:
Family Name:
Email Address:
Work Phone:
Mobile Phone:
Username:
Roles
Select the role's and the associated HTC's that you require. The HTC list will be presented for your selection when the role you have chosen requires a HTC to be selected.
Role
HTC
Terms and Conditions of Use
The Terms and Conditions of Use are important to ensure that you understand your responsibilities when using ABDR.
When requesting access to add a role in ABDR you are required to acknowledge your agreement to the Terms and Conditions of Use.
If you do not comply with your responsibilities when using ABDR your account may be suspended.
Read
the Terms and Conditions of Use
.
