Form

Project EmpowHER - Become a Partner & Request Period Products

To partner with JLOC’s Project EmpowHer and request period products, please complete the form below.

Organization Name

Organization Address

City

Zip Code

Contact Person

Contact Person's Title

Contact Person's Phone Number

Contact Person's Email Address

Please provide a brief summary regarding your Request for Partnership, to include: The Goals for this Partnership; What is the population to be served through this Partnership (demographic information regarding the total number of individuals to be served, age ranges, etc. is very helpful to our team)

Where and When Would this Partnership Take Place?

How would this partnership support the strategic goals of Project EmpowHer?

Thank you for your interest in Partnering with JLOC's Project EmpowHER! A member of the Project EmpowHER committee will be in touch regarding your request.

Cancel