DivaCup Request Form

As part of our campaign for Menstrual Equity, we are providing a limited number of students at TRU with a free DivaCup. Have you always wanted to try a waste-free period product? Sign-up below and we will have one shipped to your residence.

Your address will be used for shipping purposes only.

1. Contact Information

First Name *This question is required.

Last Name *This question is required.

Street Address *This question is required.

Apt/Suite/Office

City *This question is required.

Province *This question is required.

Postal Code *This question is required.

Country *This question is required.

Email Address *This question is required. This question requires a valid email address.

Student Number *This question is required.