Red Dot Bags Request Form

Red Dot Bags Request Form
Please complete this form to request the number of bags needed by your organization. Each bag is equipped with enough supplies to support one menstrual cycle. Additionally, please indicate if a representative from your organization will participate in the packing party.

Don't forget to mark the event date and time on your calendar to ensure attendance.
Contact Name

First NameLast Name
Contact Email
example@example.com
Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Organization Name
Organization City and State
Number of Bags Desired
I have a representative from our organization who can participate in the event, and/or collect the Red Dot Bags upon its conclusion.
Name of Organization Representative picking up/participating.
Phone Number of Representative picking up/participating.
Email of Representative picking up/participating.
example@example.com
Should be Empty: