General Application

The Health Education Learning Project is excited to announce our newest program - the Condom of the Month Club! Our club is just like a Fruit of the Month or Flower of the Month club, except our club is FREE and a lot more fun!

By completing this application you are requesting to become a member of the Club. Members get a dozen condoms plus a dozen lube packs discreetly shipped to their homes each month. The type of condom and type of lube change each month so at the end of a year you will have the opportunity to try out 12 different varieties of condoms and 12 different lubes.

Members are responsible for completing a survey at the end of each month so we can rate that month's condom and lube. A link to the survey will be sent to you on the 1st of every month and you have one week to complete it. All information you provide is strictly confidential. The next month's shipment of condoms and lube will be mailed to you once your survey has been returned.

You must complete the survey every month to continue as a member of the club and receive free condoms and lube.

Question Title

* 1. Do you want to procede to the application for becoming a member of the Condom of the Month Club so you can receive free condoms and lube?