Voluntary Euthanasia Society of New Zealand Inc
Membership Subscriptions:
Single: $15 p.a. Couple: $25 p.a. Life Membership: $150
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Please print the form below, fill it in and send with a cheque for the appropriate amount to the appropriate address for the branch you wish to join.

The demarcation line between the Auckland & Wellington branches normally runs north of New Plymouth & Taupo & across to north of Wairoa.

For the Auckland branch post to: PO Box 26 095, Epsom, Auckland 1030.

For the Wellington branch post to: PO Box 5677, Lambton Quay, Wellington 6001
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Voluntary Euthanasia Society of New Zealand Inc.

Application for Membership
I support the aims of the Voluntary Euthanasia Society of New Zealand and wish
to apply for membership.
Name(s) in Full:
(Mr, Mrs, Miss) .................................................................
Occupation ....................................
(Mr, Mrs, Miss) .................................................................
Occupation ....................................
Address .......................
...............................
...............................
Postcode ........
Signature(s).......................................
. ......................................
Phone No. ...................................... E-mail Address .............................
Date ......................................
Enclosure:
Membership .....................Donation ...........................Total ................................