Euthanasia Discussion Form

 
Details provided in this form will only be reviewed by the office of the State Member for Caloundra and will not be sent to any other party without your verbal and written permission.
Please note: this is NOT a formal submission to the HCDSDFV Committee on the Inquiry into aged care, end-of-life and palliative care.
Name *
Name
Address *
Address
Consent *
I give consent for the Office of Mark McArdle, State Member for Caloundra to contact me in relation to the information I have provided today.