LGBTQ+ individuals experience higher rates of breast and chest cancer than their cisgender or heterosexual counterparts. The Check 'em Challenge is a breast and chest cancer prevention education campaign designed to encourage breast/chest cancer screening in the LGBTQ+ community. Thank you for taking our challenge.

Please note that items will not begin shipping until June 15th, 2021

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* 1. First Name

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* 2. Middle Name or Initial

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* 3. Last Name

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* 4. Valid email address

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* 5. Would you like to receive information about upcoming Equitas Health Institute events?

Please provide the entirety of your mailing address below if you would like for us to ship your items. 

Filling out the mailing address in its entirety below will give us authorization to ship to that address. 

If you do not want us to ship your items, please include City and State/Province for our records (you may select another nearby city or town if you would like).

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* 6. Please provide the name you would like on the packaging for any mailings, if different than listed above.

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* 7. Street Address Line 1

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* 8. Street Address Line 2

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* 9. City

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* 10. State

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* 11. Postal / ZIP Code

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* 12. What is your gender identity? Check all that apply.

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* 13. What is your sexual orientation? Check all that apply.

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* 14. What is your race/ethnicity?

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* 15. Do you identify as Hispanic, Latinx, or Spanish Origin?

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* 16. Please select your age range

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* 17. Do you accept the “Check ‘em Challenge?”
Saying yes means you commit to breast/chest self-exams or routine mammograms as determined by your age/risk factors.

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* 18. If you have accepted the challenge, what item would you like?

TEA INGREDIENTS

"Breathe Deep" Femme Design
Organic Rooibus, Wildcrafted Elderberries, Organic Hibiscus, Flowers, Organic Orange Peel

"Breathe" Masc Design

Organic Sencha, Organic Peppermint, Organic Spearmint, Organic Orange Peel, Organic Thyme

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* 19. If you have chosen a shirt, please tell us what size shirt you would like to receive (if any). If your size or color is unavailable, a substitute will be used.

If you did not choose a shirt, select "N/A"

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