Mainstay Registration Form - Alcoholics Anonymous Aotearoa/New Zealand

Name of person placing order*

E Mail Address of person placing order*

Post Mainstay to (name and address)

Please provide complete postal address

Email Mainstay to: (name and email address)

Invoice Delivery (how you want to receive your invoice)*

Post/Email Invoice To*

Group Name (if order is for a group)

Group Number (if known)

Contact Ph No (that GSO can contact if there are questions re this order)*

Subscription Type. Please note you must make payment before the mainstay will be sent.*

Please select the Type of Subscription based on what month you are joining up

Payment Method*

Please select how you plan to pay