National Palliative Care Week 2019: Resource Order Form

Contact Details

Question Title

* 1. Please provide your contact details:

Contact Name

Organisation

Organisation Address

Organisation Address 2

Organisation City/Town/Suburb

Organisation State

Organisation Postal Code

What is your role in your organisation?

Email Address

Phone Number

Question Title

* 2. If your organisation a Organisational Member of PCQ?
(please note this is not essential to request resources for national palliative care week)

Yes

No

We're planning to join

Other (please specify)

Question Title

* 3. Will your event include raising funds/collecting donations for Palliative Care Queensland?

Yes

No

Other (please specify)

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* 4. We encourage you to consider selling some PCQ "I Care for Palliative Care" merchandise at your event?
Please see the list below and enter the amount you would like us to send or deliver to you (please note all unused merchandise must be returned or purchased).
View the merchandise here: https://palliativecareqld.org.au/i_care_for_palliative_care/

Fridge Magnets (business card size)

Badge (small)

Mug

T-Shirt

Drink Holder

Bumper Sticker

Tote Bag (minimal available)