JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Community Request Form
Moon Time Sisters is a volunteer organization whose mission is to help northern communities gain access to menstrual products. We gather products and ship them to communities completely free of charge.
Please fill out the following questionnaire to help us gather and prepare items best suited to your community.
Sign in to Google
to save your progress.
Learn more
* Required
Community Name
*
Your answer
Contact Name
*
First and Last
Your answer
Email
*
Your answer
Phone number
*
Your answer
What is your relationship to the community?
*
Are you a member, a teacher, doctor, nurse, or other professional in the community?
Your answer
Roughly how many people who menstruate are in your community?
*
Your answer
Please indicate which products you would be interested in receiving.
*
Disposable pads
Tampons
Menstrual cups
Cloth pads
Required
How will the products be distributed to members of the community?
*
Your answer
What is the price range for a box of pads and/or tampons in your community?
*
Your answer
Which airlines fly cargo into your community?
*
Your answer
Please provide an address and contact name for shipping purposes.
*
Your answer
Do we have permission to mention your community's name in our social media feeds, website, e-mails etc?
Your answer
By submitting this form and checking the box below, I do hereby declare that I will ensure donated products will be provided to community members free of charge as per the Moon Time Sisters mandate.
*
Confirm
Required
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
