RISE (Risk Intervention and Safety Education) invites you to fill out the form below to order and pick up condoms, pads, and tampons PICK UP DATES: Are FRIDAY's 9/25/20, 10/16/20, 10/23/20, 10/30/20, 11/13/20, 12/4/20 from 1:30pm - 3:30pm outside of DRANE HALL (between the SUB and University Ave). If you have any questions please contact rise@ttu.edu or 806.742.2110
Please fill out form below and enter which dates you would like to pick up from!

Question Title

* 1. What is your first name and last name?

Question Title

* 2. What is your preferred contact info? (in case we need to contact you because what you ordered we are out of) (ex: cell (xxx-xxx-xxxx) or ttu email (xxx@ttu.edu)

Question Title

* 3. Would you like to be on RISE Email list about events and programs?

Question Title

* 4. How did you hear about this event?

Question Title

* 5. Have you used RISE services (of any kind) before?

Question Title

* 6. Please check below what contraception you'd like:

Question Title

* 7. Please check below what contraception you'd like: (not available pre order post 9/25)

Question Title

* 8. Which dates would you like to pick up from?

Question Title

* 9. Anything else you'd like us to include?

T