MailOUT Request Form

MailOUT Request Form

We’re honored to support our trans and gender-expansive community members across rural areas. Please complete this short form to request affirming items such as undergarments, binders, menstrual care products, harm reduction kits, or literature. All information is confidential and used only to mail your requested items.
Full Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Would you like to receive updates about OUTMemphis Trans Services programs/events or newsletter?
Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
What kind of items are you requesting? Check as many that apply.

Other
Size Information: Chest size, waist size, or preferred fit
Please share anything you’d like us to know about why you’re requesting these items or how we can best support you:
How did you hear about this program?

Other
Consent Statement:
Should be Empty: