International Donation Outside the US & Canada

Name*
Last Name*
Organization Details

If you are an individual please type NA
Website
Facebook
Instagram
Twitter
Other
Telephone*
Email*
What countries does your organization work in?
Where is the community located where the DivaCups will be donated?
Does the region or community you are working in have access to potable water (safe to drink) that has been tested to be safe and can be accessed at all times?
Does your organization have the infrastructure to ship to the final destination?

We prefer to ship within North America.
Are you familiar with this country’s laws, regulations and licensing requirements for the distribution of medical devices, or menstrual care products?

The DivaCup is classified as a medical device and in most regions, licensing is required.
Who are you interested in distributing The DivaCup to?
What items are you requesting for donation? (Tick all that apply)
- Model 0
- Model 1
- Model 2
- Demonstration Kits
- Educational Materials
Model 0 Amount
Model 1 Amount
Model 2 Amount
Demonstration Kits Amount
Educational Materials Amount
Can your organization provide soap to clean the DivaCup?

Please note that The DivaCup has to be cleaned with non-scented, oil free fragrance free soap 2-3 times a day.
Does your organization have access to staff who have medical training, preferably in women's health
Is there a health care provider or community clinic where individuals using the cup for the first time can be referred to?
Does this community have access to adequate medical services? (For a Medical Trip request)
Once the donation has occurred, will the community continue to have access to menstrual product and health support?
Are there members of your organization/cause who are willing to receive a (20 min) DivaCup Q&A session over the phone/Zoom with one of our DivaCares team members?
Is your organization open to sharing media (pictures, videos, blogs) with DivaCares for the purposes of promoting your initiatives on our social media channels?
- Yes
- No