Little Poss Appeal - Order Form

Little Poss Appeal

Your support will provide telephone and face to face support for the 75,000 Queenslanders with epilepsy. Please use the form below to help us...

Further information can also be obtained by contacting Epilepsy Queensland on (07) 3435 5000 or 1300 852 853 (outside Brisbane) OR PO Box 751, Coorparoo BC QLD 4151

Little Poss Appeal 2005

Product info...

I would like to order:

Note: Each display box consists of:

- 10 Keyring Flashlights

- 10 Pens

- 5 Light Bulb Post-it Notes

- 5 Little Poss Magnetised Bookmarks

Also, Please include promotional posters

Contact info...

First name:

Surname:

My address is:

Organisation / School:

Position:

Phone number: Mobile:

Fax number:

Email address:

Please note:

Banking and return details will be forwarded with merchandise boxes and display material. Merchandise will be despatched in the week commencing June 13. Your help extends the POSSibilities.

THANK YOU!

Thank you to our major partners: Queensland Newsagents Federation, Westpac, Pharmacy Guild (QLD), Newspower and Australian Pharmaceutical Industries.