InterACT (formerly Advocates for Informed Choice) · #4intersex Website Donation Form

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Thank you for showing up #4intersex rights!

Your support means so much. We will be sure to add to our growing list of advocates, and we will periodically update you with opportunities to speak up and join the fight to protect intersex kids.

Contact Information

Name

First Name

Last Name

Verify Email

Address (*City, State and Country required, so we can direct local efforts!)

Address Line 1

Address Line 2

City

State

State/Province

ZIP/Postal Code

Country

Phone Number

About You

How would you characterize your connection to the movement?

I am a family member/friend of an intersex person

I am a human rights activist/ally

I am a student and care about intersex rights

I am an intersex person

I am part of the LGBTQ community

I am a health care provider

I am a family member or friend of an intersex person

Please select what best defines your relationship with an intersex person

Parent/Guardian

Spouse

Grandparent

Sibling

Extended family (ex. aunt, uncle, cousin, etc.)

Friend

Are you a Mental Health Care provider?

Yes

Are you a Medical Care Provider?

Yes

Please Specify

I am a

Psychiatrist

Psychologist

MSW

Other

Please Specify

I am a

Nurse Practitioner

Nurse

Other

Mental Health Provider Other

Please describe

Medical Health Provider Other

Please describe

Why are you showing up #4intersex?

Please share a sentence or two about what has compelled you to join our movement!

Anything else you'd like to tell us?

Thank you for donating!

Please tell us any other ways you are interested in showing up #4intersex:

Donating airline miles or in kind goods or services

Fundraising (asking others to donate to interACT)

Speaking up #4intersex at events and/or taking it to the streets

Grassroots advocacy (sending emails, calling your legislator, etc.)

Speaking up #4intersex on social media and/or spreading the word

Working with the medical community to help educate and influence change

Amount

$100

$50

$25

Donation Schedule

Add 3% to my total amount to help cover the payment processing fees