DIGA x Coolibar New Member Care Package

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Please fill out this form if you would like a complimentary care package provided by our partner, Coolibar! Do NOT complete this form if you have filled it out in previous years and received a Coolibar package.

***Coolibar packages can only be shipped to the contiguous United States***

If you would like to sign up for the DIGA email listserv, please go to https://derminterest.com/contact/.

If you would like to follow DIGA and Coolibar on Instagram, the handles are @derminterest and @coolibar.

Email *

Name (First and Last) *

Mailing Address *

Please format it as follows:

# Street Name

APT # (if applicable)

Town, State, Zip Code

Medical School Name *

Please spell out the entire name of your school.

Clothing Top Size *

Clothing Bottom Size *

Male or Female Clothing Size *

Male

Female

Send me a copy of my responses.

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