Order Form for Flyers

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

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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.

 
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Are you ordering on behalf of a group or organisation?
Please enter your postal address
Area code and phone number. Please type without spaces or zero in front.
Please enter your electorate
How many flyers would you like?
Please choose whether you would like the flyers folded.
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