Activist Application

1

👋 Hey, before we start, can we get your first and last name?* This field is required.

First Name

Last Name

2

& your email 📧, we'll be in touch :)* This field is required.

example@example.com

3

How old are you?

15 and under

16 - 18

19 - 35

Over 35

5

Which of the following describes your daily activity?

Moderate

Low Active

Active

Very Active

6

How does your pelvic area feel?

Tense

Relaxed

7

How heavy is your flow?

Light

Moderate

Heavy

8

How often do you change your pad or tampon?

0 - 3 hours

4 - 6 hours

9

Have you recently given birth?

YESNO

10

The DropletThe Droplet is the best fit for you! Get your Droplet here today.

11

The DripThe Drip is the perfect fit! Get yours here today

12

The DropThe Drop is the perfect fit for you! Get yours here today.

13

We are a nonprofit and we are here for YOU! If you still have more questions before purchasing please set up a short call with one of our period experts. Copy and paste the link below to do this https://form.jotform.com/212230792349455 https://form.jotform.com/212230792349455