JOIN THE PURPLE NOTE PROJECTReceive 25 personalized purple notes over a 12-month period..First Name *Last Name *Pronouns: *Age Group *18-2526-3940-5960-7475+Mailing Address *Apartment, suite, etc.City *State/Province *ZIP / Postal Code *Country *AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua & BarbudaArgentinaArmeniaArubaAscension IslandAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCaribbean NetherlandsCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong Kong SAR ChinaHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao SAR ChinaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian TerritoriesPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint HelenaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSouth KoreaSouth SudanSpainSri LankaSt. BarthélemySt. MartinSt. Pierre & MiquelonSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyriaSão Tomé & PríncipeTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad & TobagoTunisiaTurkeyTurkmenistanTurks & Caicos IslandsTuvaluU.S. Virgin IslandsUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWallis And Futuna IslandsWestern SaharaYemenZambiaZimbabweEmail: *What are some things you like about yourself? *Primary Reason for Joining the Purple Note Project: *AnxietyBorderline (BPD)Bullying or HarassmentCaregiver BurnoutChronic PainDepressionDivorce or BreakupGrief and LossHopeless or DespairLoneliness or IsolationLong Term IllnessPostpartum DepressionPsychiatric AdmissionPTSDSelf HarmStalking - Online or IRLSuicidal ThoughtsSuicide AttemptTerminal IllnessToxic WorkplaceNot Listed (Specify Below)Please share what's been going on recently: *How would you characterize the situation? *Everyday challenge or minor setbackSignificant life challenge or mental health concernSerious mental health crisisAt risk for suicideAre you member of the following groups or communities? *Abuse or Trauma SurvivorsBIPOC (Black, Indigenous, and People of Color)Elderly Age 75+Foster Care YouthHomeless PopulationSubstance Abuse or RecoveryLGBTQIA+ CommunityPeople with DisabilitiesSuicide LossVeteran or Military PersonnelYouth and AdolescentsI don't knowNoIs there anything else you'd like to tell us? *How did you hear about us? *FacebookInstagramPersonal connection to Say His NameReferred by friend or family memberMental Health ProviderPreviously received a letter🚨 Please check for a confirmation email before submitting multiple times!Thank you! Submit RequestPlease do not fill in this field. Please do not fill in this field. STAY CONNECTED Subscribe to receive updates, resources, and ways to make a difference. Name Please enter your name. Email Address Please enter a valid email address. Subscribe! Thanks for subscribing! Something went wrong. Please check your entries and try again.