Support the declaration - Citizens

Citizens' Declaration

This form is intended only for citizens who wish to support the declaration.
If you are a doctor, you can sign it here.

I have read the Declaration and I support the Physicians’ Alliance against Euthanasia *

Yes No

Prefix *

First Name *

Last Name *

Email *

Telephone Number

Address *

Address line 2

City *

Postal code *

Country *

Province/ State *

Preferred language *

Newsletter *

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Urgent calls to action *

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