This form is designed to be completed, printed and posted/faxed with payment. Phone 07 3250 0240 for more information.
Post: Family Planning Queensland, PO Box 215, Fortitude Valley, Qld 4006 Fax: 07 3250 0296 ABN 61 009 860 164
If you do not want your details to be included on future FPQ mail-outs please email info@fpq.com.au or phone 07 3250 0240.
fpq publications
Signature:________________________________________________ Please debit: $
Office Use: Purchasing Date:___________ Int:_____ Accounts Date:___________ Int:_____