Departing Drugs Order Form

Section One (To be completed by the individual ordering the booklet)

Please send me a copy of Departing Drugs. (Name:)

Mailing Address

Phone Number (optional, recommended) ........................ Date ........
I certify that this book is for my private and confidential use and that I am over 21 years of age
Signature of Buyer ................................
UNDERLINE THE PARAGRAPH THAT APPLIES:
I am a member of Exit. or
I enclose verification by a recognised right to die society society of 3 months' membership on the section that follows.

I have enclosed £..........(amount in GB Pounds Sterling) to cover purchase price, postage and administration, plus any donation I wish to make at this time. (See information in the third section of this form).

Please debit my credit card (Visa / Mastercard) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Expiry date: _ _ / _ _ Amount in Sterling: £ ..........

Security number ........... (last three digits on reverse of card)

Signature ................................

Section Two (To be completed by an official of a Right To Die Society).

..................................................... (name of member), is a member of our Society and has been for at least three months, and is over 21 years of age; also, we know of no reason why he or she should not receive the booklet "Departing Drugs".

Name/Position of Representative and official stamp:

Signature ................................ Name of Society .................. Date ........

Section Three (Ordering Information)

N.B. If making an advance purchase at the same time as applying to join Exit, please enclose photocopy of driving license, passport or other proof of age.
GB POUNDS STERLING 8 POUNDS (within UK) or 10 POUNDS (outside UK) inclusive, Payable to: Exit, 17 Hart Street, Edinburgh EHl 3RN, UNITED KINGDOM. N.B. For ordering in language other than English, see list of licensed distributors and deal directly with them, not with Exit. For further help and advice on payment methods, please see our payments guide.

Important

Please do not send your order separate from payment. All documentation and payment must arrive in the same envelope.
Please allow up to several weeks for processing.
Please enclose the appropriate verification by a recognised right to die society. If the society of which you are a member is unwilling or unable to do this then you must apply to join Exit and apply for the booklet after three months. You may pay for the booklet and membership at the same time if you wish, but a further request after three moths will be required.
Please do not send payment in any currency except British Pounds Sterling. If you pay by credit card we will deduct the appropriate amount in sterling and you will be debited in your own currency by your credit card company.
Incorrectly completed paperwork will be returned.
We recommend that you join Exit, even if you are already a member of another right to die society - only by joining Exit will you be able to receive the essential self-deliverance updates published in our magazine to members.
No other correspondence is necessary. If you include your reasons for ordering the booklet there may be legal difficulties in granting your application.
If you have any preliminary enquiries about the information on this website, please send a short email to us using the feedback page. We reply to emails time allowing (note that after May 2003 Exit is manned entirely by volunteer staff and usually only one person, part time, so delays are inevitable sometimes and we may not be able to reply to long, detailed enquiries personally.)