Community Outreach

Our Pledge

Summary

Community Outreach Form

Request DisposeRx Packets

Please fill out the form below to request DisposeRx Packets.

Contact Infomation:
Organization Address
Organization Ship-To Address
Number of Packets Requested
Max words: 500
BRIEF DESCRIPTION

In 500 words or less, please describe your organization and the program for which you are requesting donated DisposeRx Packets.

Submit

Thank You

Thank you for your interest in DisposeRx. We will follow up with you in the near future.

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