Free Condoms!

Please fill out the below form to request Prevention Supplies.

* Indicates required field

Name - Please note that we will only send out condoms if you put your first AND Last (Full) Name *

First

Last

Address - Required if Mailing -- We Will ONLY Mail to Addresses Located in the state of KANSAS *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Choose Delivery Option *

Regular Latex Condoms *

Non-Latex Condoms - PLEASE READ: ONLY ORDER if you ARE ALLERGIC TO LATEX!!! If you Order NON-LATEX condoms, we will NOT send out any other type of condom with your order. *

Extra Large Condoms *

Flavored Condoms - For ORAL SEX ONLY *

Lubricants *

Oral/Dental Dams - For Oral Sex *

Female Condoms *

Key Chain *

Please put amounts needed, any comments or special requests below. Large Orders will be referred to our Outreach Department for business and requests for Condom DIspensers. *

Name - By Typing this name you are stating that you are the above person and you are requesting these items in good faith. Impersonating another individual or requesting items for another person is strictly illegal. The IP addresses of those impersonating another individual will be given to local law enforcement. *

First

Last

Submit

Do you need FREE STI Prevention Supplies? Condoms, Oral/Dental Dams, Lubricants, non-latex condoms? Stop by our office or fill out the form below!**Please note that due to supply and demand, we will ONLY send items to addresses located IN KANSAS**

Please fill out the below form to request Prevention Supplies.

Do you need FREE STI Prevention Supplies? Condoms, Oral/Dental Dams, Lubricants, non-latex condoms? Stop by our office or fill out the form below!

Please note that due to supply and demand, we will ONLY send items to addresses located IN KANSAS