MPDP Application Apply here to begine receiving free menstrual products from The PATESI FoundationPLEASE COMPLETE THE FORM BELOW Name of Recipient * First Name Last Name Email * Phone * (###) ### #### Address of Recipient * Address 1 Address 2 City State/Province Zip/Postal Code Country Line Are these products for yourself or someone else? * For myself For someone else How many people in your household need products? * 1 2 3 4+ What types of products are you interested in? Pads Tampons Menstrual Cups Menstrual Discs Wipes Period Underwear Maternity Pads or Depends If we do not have your product preference available, would you still like a delivery of other menstrual products that we have in stock? * Yes (if so, let us know your preferences below) No Would you like to be added to the waitlist for products that are out of stock? Yes No Let us know below if you have any other suggestions or ways we can help end period poverty. You can also add anything else you would like for us to know for your application. Thank you for your application! We will get in touch with you soon.