Competition Form – Keeping it Local NZ

To enter a competition in one of our editions, please fill out the form below

By filling in this form you agree for your details to be passed onto the business you patronized, and to receive offers / deals from our network of goods and service providers in your area.

Full Name

Phone Number

Email Address

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

What Business did you make your purchase from?

What Edition did you read?What Edition Did you Read

What venue did you pick up your copy of "keeping it local"?

Gender

Date of Birth