Order Merchandise

Required fields are marked with a star: *

Please send me:
Butterfly box/es  
A standard box contains:
A poster, bank deposit slip, “How To Participate”, and information about Hear and Say:
20 x $3 butterfly brooches
5 x $5 butterfly charm bracelets
10 x $5 butterfly key rings/bag tags
20 x $3 butterfly mini bling pens
Total retail value = $195
Additional Merchandise
$3 Butterfly brooches
$3 Mini Butterfly Pens
$5 Butterfly Charm Bracelets
$5 Butterfly Charm Key/Bag Tags
$5 Lapel Pins
$3 Wristbands
Personal details
Title
First name *  
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Organisation
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Delivery details
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(Street address only)		  
Suburb *  
Postcode *  
Delivery Instructions
When would you like your merchandise delivered? *
Contact details
Postal address
(if different from above)
Suburb
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Daytime phone *  
Evening phone
Mobile
Email *