Gender Junk Request Form
Email address *
First and Last name? *
What are your pronouns? *
If you use different pronouns, what do you use?
How do you identify? (Check all that apply) *
If you identify differently, please tell us how you identify
How old are you? *
Street Address *
City, State Zip code *
Is this your personal address? *
What is your phone number? *
Are you out to your parents/caregivers? *
Describe your situation to us a little bit. *
What item(s) are you hoping to receive? *
What is the best way for us to contact you? *
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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