I would love to send you or someone you love a zines. One request per person, please. I will not share your info or use it for anything other than this purpose.

Recipient's Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email Address

Your Name (if this will go to someone else)

Any other (short) message for the recipient?