Register For Endo/PCOS/ADNO-Surgery pack 

Please only fill out this form if you are having surgery for ENDO/ADNO/PCOS- we have very limited boxes

THIS IS NOT THE FREE PERIOD PACK REQUEST FORM:

All information collected is confidential and is used for stats, Please advise your date of surgery and hospital eg: Wellington Hospital and if you have any allergies.  Not all boxes are the same, it all depends on what has been donated and what we have available. ​I would appreciate it if you can help cover the postage cost for your pack, each pack is valued at over $40+ if not more, not all items are donated from businesses, I purchase items as well.

 

I would appreciate a donation/koha to help cover the postage cost, Postage cost $8.50 -  $15 for RD address so we ask you to help pay that, as unfortunately the more we spend on postage the fewer packs I can send out, I don't get any funding etc to do this, I have to fundraise money myself etc by paying for postage allowed me to buy items for more boxes and be able to send more out.  - Info Below ​

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Surgery Boxes Only available in Aotearoa /New Zealand

Do u hae any allergies ?
Wher did you hear about EWA Surgery Boxes?
Some of our items we are given say things like "for women" if you don't want these and want a gender neutral box please tick below
At times we are given other items for boxes but they may not be for evryone, please only tick if you would use these items, you may not get any/all of them (as depens on numbers)
Do you need period pads for you surgery care?
Postage - please pay to bank account listed above

You can pay for postage  via PAYPAll Link below or deposit into ANZ Endo Warriors Aotearoa  06-0582-0971121-00 Reference: Your Name and Surgery Pack 

Your request has been sent