Vote on Stopping School Violence

Coalition for National Referendum

Vote on Voluntary Euthanasia

Please fill out all fields. You may 'Print' this form if you would rather mail the vote. Otherwise, click on 'Submit' when finished. Thanks!

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Title:

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Question 1: Do you believe that dying persons should have access to lawful, medical, voluntary euthanasia if they wish to terminate their suffering?
Yes
No

If you wish to get the result of this and other votes, please return to our home page and join our mailing list. Thanks!

If you wish to mail the ballot, mail to:
Coalition for National Referendum
99 Clinton Street Suite 111
Concord, NH 03301

Please feel free to copy and print this ballot page and distribute to others so that they may vote. You can also send more than one person's ballot in the same envelope. We do remind you that all ballots will be verified by voting records. It is not necessary to have an email address for those votes submitted through the regular postal mail system. Thank you!

Title:
First Name:	*
Middle Initial:
Last Name:	*
Address:	*
City:	*
State:	*
Zip Code:	*
Phone Number:	( )*
Email:	*