• Join the Condom Club!

    Thank you for your interest in our Condom Club! We collect basic information below to be able to send FREE condoms and/or lube directly to you. Your information is always kept confidential according to strict HIPAA guidelines. Supply is based on current stock and available funding.

  • Club Preferences

    NOTE: Condom type and amount may change from month to month and is based on donations received. We will do our best to fill your request whenever possible!
  • I would like to receive 25 condoms.*
  • Condom Preference (Select ONE option):*
  • I would like to receive 25 foil packets of lube.*

  • Contact Info

  • Preferred Language*
  •  -
  • Are you able to receive text messages at this phone number?*

  • Demographics

  • Gender*

  • Sexual Identity*

  • Do you identify as Hispanic or Latino?*
  • Race (Check all that apply)

  • How long has it been since your last HIV test?*
  • Which best describes your use of PrEP (Pre-Exposure Prophylaxis)?*

  • Sexual activity requiring condoms: (Select ALL that apply)*

  • How did you learn about EAC's Condom Club?*

  • Are you interested in any of the following? (Select ALL that apply)*

  • Should be Empty: