Request Trial Newsletter
(Read everything below - you'll feel better about this I promise!)

Privacy

Information provided by you is kept strictly confidential and is NOT released to ANYONE except our elected group officers.  The information below is used for statistical purposes so we can track various things like ages, sex, and locations throughout the metroplex.  Our group is open to anyone who is single and has Herpes or HPV regardless of age, sex, race, or sexual preference.

Arrival

The newsletter will arrive to you via e-mail unless you specify otherwise.  The newsletter does NOT contain the word Herpes.  If you request that the newsletter be mailed via US Mail the newletter has NOTHING that would identify that we are a herpes group in any way.  Upon completion of this form you'll receive a confirmation e-mail that explains how our events work.  The event calendar itself will be sent to you after your information is reviewed by our new member coordinator.  Don't worry!!  Relax!  We have all been in your shoes before!!

Contact

If you would like someone to call you, please specify that in the comments area.  You may want to suggest alternate telephone numbers and the best time to call you.  They will not announce in any way the nature of the group or the call to anyone should someone else answer your phone.  Don't worry!!  Relax!  We have all been in your shoes before!!

Newletter Format

The e-mailed version of our newsletter comes in .PDF Format (Adobe).  You will need the Adobe Acrobat Reader installed on your computer in order to read the e-mail version of the newsletter.  You will be provided a link to download this free utility after you complete the form below.  The confirmation e-mail also contains this link as well so you can download the free reader utility at your convenience later.

** ALL FIELDS BELOW ARE REQUIRED **

Name: 

Phone #: 

Address: 

E-Mail Address: 

City: 

Date of Birth (mm/dd/yyyy): 

State: 

How did you hear about us? 

Zip Code: 

Sex: 

    

Comments: