Flyer Orders

Order Form for Flyers

Please enter your details below to order this double-sided A4 flyer.

View the Front View the Back

We are making these flyers available at no charge,
but would be very grateful for a donation towards our campaign.
(About 20-30c per flyer would cover our costs, but any amount is welcome!)

Deposits can be made into this account:
Euthanasia-Free NZ Inc.
38-9014-0763579-00
Kiwibank Onehunga
(Please add 'donation' as reference).

If you would like a receipt, please indicate that below.
Unfortunately donations are not tax deductible.

If you have any questions or would like help with your order,
please contact us at info@notoassistedsuicide.nz or 0800 42 76 42.

* indicates required

Name: Email: Comment:

Email Address *

First Name *

Last Name *

Name of Group / Organisation (if applicable)

Are you ordering on behalf of a group or organisation?

Postal address *

Street Address Address Line 2 City State/Prov/Region Postal/Zip Country

Please enter your postal address

Phone number *

Area code and phone number. Please type without spaces or zero in front.

Electorate *

Please enter your electorate

Number of flyers *

How many flyers would you like?

Donations

Yes, I will make a donation to help cover costs.
Please send me a receipt.