Gender Junk Request Form
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Email *
First Name *
Last Name *
What are your pronouns? *
Required
If you use different pronouns, what do you use?
How do you identify? (Check all that apply) *
Required
If you identify differently, please tell us how you identify
How old are you? *
We host multiple support groups for different ages, which of these groups best describes you? (We use this data to best connect you with other resources you might be interested in in our initial email to you. You will not receive more emails from us based on your selection.) *
Street Address *
City *
State *
Zip Code *
Is this your personal address? *
Is this a safe address for us to ship to?
Clear selection
What name would you like on an order/package made out to you?
What is your phone number? *
Are you out to your parents/caregivers? *
Describe your situation to us a little bit. *
What item are you hoping to recieve? (At this time, our program can only accommodate one "item" per request.) *
What is the best way for us to contact you? *
Required
If you listed "social media" as the best way to contact you, please tell us what platform and your username (ex. Instagram @transfamilysos). If you did not choose social media, please put "n/a" *
How did you find out about our Gender Junk Program? *
A copy of your responses will be emailed to the address you provided.
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