Condom Request Form
For Student Events and Presentations on the SDSU Campus.
Today's Date *
MM
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DD
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YYYY
Name *
Your answer
Phone Number *
Your answer
Email address *
Your answer
Organization you represent *
Title of Event or Type of Activity *
Your answer
Date of Activity/Event *
MM
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DD
/
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
Submit
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