Condom Distribution Application

CONDOM DISTRIBUTION APPLICATION

Organization Information


             

   

   

Does your organization agree to the following?


   

   

In each of the categories below, please check ALL that apply for your organization


       

       

           

             

             

   

   

1 case = 1,000 male condoms

1 bag = 100 female condoms


         

   

 

This acts as your Electronic Signature

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