InterACT (formerly Advocates for Informed Choice)

Amount

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$100

$50

$25

$

Donation Schedule

Contact Information

Name

*

First Name

Last Name

Email

Address

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Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Phone

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

I am not sure if my employer will match my donation

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?