PRINTABLE ORDER FORM

Name: _____________________________________

Address: __________________________________

___________________________________________

___________________________________________

Country: __________________________________

Email: ____________________________________

Date of order: _____________________

TSV ORDER                                                   Totals:

[ ] Current Issue (# ____)                              NZ$__________

[ ] Following Issue (# ____)                            NZ$__________

[ ] Back Issues (# ____ , #_____,  # _____, # ______)   NZ$__________

                                                 Total: NZ$__________

                            Conversion (currency: ___)  _____________

Make payable to: New Zealand Doctor Who Fan Club

MAIL TO:

New Zealand Doctor Who Fan Club
PO Box 33314
Takapuna
Auckland 0622
New Zealand