Condom of the Month Club

JOIN CONDOM OF THE MONTH CLUB
CHANGE MY ADDRESS CANCEL MEMBERSHIP

Who can Join?

You must be a gay or bisexual man or a transgender female
You must be over the age of 18
You must live in the DFW area
You must have a current email account
The program has a finite number and we may limit membership to insure deliverability and diversity of club membership

What is it?

Condom of the Month is a FREE service where club members will receive 12 condoms and 12 lube packets via the US Mail every month. The brand of condoms and types of lube will change each month and they will arrive in discreet packaging.

Why Join?

This program is designed to increase the availability of condoms in our community. 60% of gay men surveyed last year reported that they have run out of condoms or did not have a condom when they needed one in the past year.

Grief & Loss Counseling Group - Sign Up Request Form

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First Last
Phone*
Email*
Newsletter Sign Up
- Subscribe me to HELP Center's monthly newsletter & program updates
Address*
Street Address Address Line 2 City State ZIP Code
When was the date of your loss?*
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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Email
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35816

COVID-19 Anxiety Counseling Group - Sign Up Request Form

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Newsletter
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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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63145

Individual Counseling - Sign Up Request Form

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Phone*
Email*
We guarantee 100% privacy. Your information will not be shared.
Newsletter
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Address*
Street Address Address Line 2 City State ZIP Code
Briefly describe why you are seeking counseling.*
All information that you provide us will be confidential as required by state and federal law.
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81919

Transitioning Women's Support Group - Sign Up Request Form

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First Last
Phone*
Email*
Newsletter
- Subscribe me to HELP Center's monthly newsletter & program updates
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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90761

Condom of the Month Club - Change of Address Request

Name*
First Last
Email
Old Address*
Street Address City State / Province / Region ZIP / Postal Code
New Address*
You must live in the DFW area to be eligible for this program.

Street Address City State ZIP Code
Phone*
All change of address requests will be voice verified.
Comments
This field is for validation purposes and should be left unchanged.

11997

Condom of the Month Club - Cancelation Request

Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
All cancelation requests will be voice verified.
Email*
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.
Cancelation Reason - Other*
Please describe your reason.
Email
This field is for validation purposes and should be left unchanged.

4698

Join the Condom of the Month Club!

Condom of the Month Application

Name*
First Last
Address*
*You must live in the state of Texas in the DFW area to be eligible for this program.

Street Address Address Line 2 City State: Texas Only ZIP Code
Phone*
All online applications will be voice verified.
Email*
We guarantee 100% privacy. Your information will not be shared.
Email Newsletter Opt-in
- Subscribe me to HELP Center's monthly newsletter & program updates
Ethnicity*
Other Ethnicity*
Gender*
Other Gender*
Sexual Orientation*
Other Reason*
Age*
Birthday
MM
DD
YYYY
Consent
I agree to the privacy policy.
Email
This field is for validation purposes and should be left unchanged.

3264

Condom of the Month Club

Who can Join?

What is it?

Why Join?

PREP SUCCESS RATE
IN THE PREVENTION OF
HIV TRANSMISSION

FREE CONDOMS
DISTRIBUTED IN 2021

FREE HIV TESTS
CONDUCTED IN 2021

PrEP PATIENTS SEEN
IN 2021

Grief & Loss Counseling Group - Sign Up Request Form

COVID-19 Anxiety Counseling Group - Sign Up Request Form

Individual Counseling - Sign Up Request Form

Transitioning Women's Support Group - Sign Up Request Form

Condom of the Month Application

Volunteer

Condom of the Month Club

Who can Join?

What is it?

Why Join?

PREP SUCCESS RATE IN THE PREVENTION OF HIV TRANSMISSION

FREE CONDOMS DISTRIBUTED IN 2021

FREE HIV TESTS CONDUCTED IN 2021

PrEP PATIENTS SEEN IN 2021

Newsletter

PREP SUCCESS RATE
IN THE PREVENTION OF
HIV TRANSMISSION

FREE CONDOMS
DISTRIBUTED IN 2021

FREE HIV TESTS
CONDUCTED IN 2021

PrEP PATIENTS SEEN
IN 2021