CCI Support Newsletter Opt in

Opt-in to CC Support Newsletters

Name *

First name

Last name

I would like to receive the Newsletters by: *

This is giving us permission under the Unsolicited Electronic Messages Act 2007 to send you the Newsletter. Please Opt out, if you do not wish to receive it.

Email address

Address

Address line 1

Address line 2

Address line 3

Address line 4

Town/Suburb

City

Postcode/Zip

Phone

Feel free to donate

Complex Chronic Illness Support is a charitable organisation, and as such we rely heavily on grants from external Funders and donations to cover our operating costs, newsletters and running the Programmes. We are so grateful for your support.

These donations are tax deductable and a receipt will be sent to you after 1 April 2021 to upload to IRD.

Donation towards CCIS *

Payment method

Pay CCIS by credit card - Donation

Pay CCIS by internet banking
Make deposit to account
38-9014-0140507-00

Consent to collect information.

I authorise the collection of information that may be relevant to my donation.

I understand that in the collection, use and storage of this information, Complex Chronic Illness Support will at all times comply with the Privacy Act 1993 and the Health Information Privacy Code 1994.

I understand that I have the right to access and ask for the correction of any information, Complex Chronic Illness Support may hold about me.

I consent to CCIS retaining my information and keeping in touch with me. *

THANK YOU!!!

Thank you for supporting Complex Chronic Illness Support.

Kind regards,

The Team at CCI Support

43 Welcome Bay Rd, Welcome Bay, Tauranga 3112
022 658 0251  07 281 1481  info@ccisupport.org.nz  www.ccisupport.org.nz