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Condom Request Form
For Student Events and Presentations on the SDSU Campus.
Today's Date
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Name
Your answer
Phone Number
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Email address
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Organization you represent
Title of Event or Type of Activity
Your answer
Date of Activity/Event
MM
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DD
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YYYY
Time
:
Distribution
Please provide a brief description of how the condoms will be distributed.
Your answer
More details
Your answer
I am requesting...
Required
If you are requesting condoms how many are you requesting? (note: the max is 100)
Your answer
If you are requesting lubricant how many packets are you requesting? (note: the max is 50)
Your answer
Requesting educational materials, chose one of the following.
Required
Distribution Agreement
Required
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