Please Complete the Request Form and Email To

HIV and Sexual Health Resources

Request Form

(Colleges)

Please complete the request form and email to

College Name:
College Address:
Your Name and Position:
Student/College Society Name:
Telephone Number:
Email Address:
General Data Protection Regulation: / Please let us know if we can add your email address to receive future correspondence about our education and training services: / Yes
 / No

Event/Project:
(e.g. Freshers Week; SHAG Week; Health Promotion event, etc.)
By what date do you require the materials?
Collection and Delivery / Collection: Dublin-based colleges are requested to organise collection of the resources from our offices. You will be contacted when your request is ready for collection.
Delivery: Resources will be posted to colleges based outside of Dublin only.
Resource List / Quantity Requested
(please enter a quantity)
Condom and Lube Packs (Max: 200)
(each pack contains one condom and one lubricant sachet)
HIV Ireland: Services and Support Information Leaflet(Max: 30)
(An information leaflet about the services and support provided by HIV Ireland)
A3 Poster: Free Condoms @ HIV Ireland (Max: 2)
(A3 poster promotingthe free condoms service at HIV Ireland)
HIV: Know the Facts(Max: 50)
(An 8-page information leaflet about HIV)
G Booklet (GHB, GBL) (Max: 50)
(A harm reduction information booklet about the drug GHB)
PEP and You(Max: 30)
(An information leaflet about Post Exposure Prophylaxis (PEP) - a medical treatment that can help prevent HIV infection)
Gettin’ It On: A Guide to using condoms(Max: 30)
(A comprehensive guide on how to use condoms correctly with some useful tips)
A3 Poster: A Guide to using Condoms correctly (Max: 2)
Get Tested:
A Guide to free HIV, STI and Hepatitis Testing in Ireland(Max: 30)
(A detailed guide including information on all the free public HIV and STI testing around Ireland)
Chlamydia(Max: 30)
(An 8-page information booklet about the STI, Chlamydia)
OMG…Gonorrhoea(Max: 30)
(An 8-page information booklet about the STI, Gonorrhoea)
Luv Bugs: Syphilis(Max: 30)
(An information leaflet about Syphilis for men who have sex with men)
Luv Bugs: Gonorrhoea(Max: 30)
(An information leaflet about Gonorrhoea for men who have sex with men)
Luv Bugs: Chlamydia(Max: 30)
(An information leaflet about Chlamydia for men who have sex with men)
Luv Bugs: LGV(Max: 30)
(An information leaflet about Lymphogranuloma Venereum – LGV – for men who have sex with men)
Hepatitis B: 4 Steps to Immunity(Max: 30)
(An information leaflet about Hepatitis B for men who have sex with men)
Red Ribbons(are only available if you are holding a fundraising event for HIV Ireland)

Email the completed Request Form toand we will be in touch with you in relation to your request as soon as possible.

Please note that all requests are subject to the availability of resources.

The maximum quantities are ‘per order’. You are welcome to submit additional orders when your current resources have been used up.

If you require more than the maximum quantity, please email us to explain why.

By submitting this form you agree that you will adhere to our guidelines for the use of the HIV Ireland condom packs, i.e. that condom and lube sachets will remain intact for distribution and will not be removed from the

‘Just Carry One’ branded packaging.

Thank you.

July2018Page 1 of 3