ALRANZ

The Abortion Law Reform Association of

New Zealand (Inc)

PO Box 28-008 Wellington

Our subscription is:

$10.00 per annum (waged)

$5.00 per annum (unwaged)

I would like to become a member of ALRANZ and enclose my subscription

I would like to make a donation of $….........

I am interested in:

………………………………………….....................................................................................

Name: ………………………………….....................................................................................

Address: ……………………………….....................................................................................

…………………………………………....................................................................................

…………………………………………....................................................................................

Telephone: ……………………………

Email: ...............................................

Please tick if you would like to receive your quarterly newsletter by email ...........

Post cheque to The Treasurer, ALRANZ, Box 28-008 Wellington

or deposit amount in ALRANZ BNZ bank account 02-0534-0128842-00

Please tick if you require a receipt and enclose a stamped self-addressed envelope ..........