Central District Health Condom Distribution

Central District Health is working with local establishments (i.e. breweries/bars/wineries/ and any business of interest) to provide free condoms.

Submit your contact information if you would like to receive condoms at your local business or establishment. CDH will mail or deliver them to your place of business.

Question Title

* 1. Please add your contact information if you would like to receive free condoms at your place of business.

Name

Company

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 2. How many condoms would you like? The smallest box count is 50 and the largest box ranges to 1,000.

50 (one box)

100

500

1,000

Other (please specify)