InterACT (formerly Advocates for Informed Choice)

Amount

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$100

$50

$25

$

Donation Schedule

Contact Information

Name

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First Name

Last Name

Email

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Address

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Address Line 1

Address Line 2

City

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My Employer

Employer Matching

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My employer will match my donation

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Please let us know if your employer matches charitable contributions

Yes, my employer will match my donation

No, my donation is not eligible for employer matching

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We are so thankful for your generous gift. What compelled you to give to interACT at this time?

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

No

Please Specify

I am a

Psychiatrist

Psychologist

MSW

Other

Are you a Medical Care provider?

Yes

No

Please Specify

I am a

MD

Nurse Practitioner

Nurse

Other

Mental Health Provider Other

Please describe

Medical Health Provider Other

Please describe

What would you particularly like to see from interACT in the future?