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Address*
Street Address Address Line 2 City State ZIP Code
Briefly describe why you want to join this group.*
All information that you provide us will be confidential as required by state and federal law.
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Condom of the Month Club - Change of Address Request

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You must live in the DFW area to be eligible for this program.

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All change of address requests will be voice verified.
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Condom of the Month Club - Cancelation Request

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All cancelation requests will be voice verified.
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We're sorry to see you go. Please help us improve our service by letting us know why you decided to cancel.*
Your responses will be kept confidential and will not be shared with any other party. Responses will only be used to help improve HELP's free Condom of the Month Club service.
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