Gather Petition Signatures

Thank you for willingness to help collect petition signatures to put the Death with Dignity Act on the ballot. Your support could not come at a better time as we have just a few weeks to collect nearly 70,000 signatures. Please answer the questions below and we will mail you a kit with instructions, blank petition sheets, and a return envelope.

First Name:
Last Name:


Who will you ask to sign the petition?
 My family, friends, and neighbors.
 People at a public location, like outside a library or shopping center.
 People at an organizational meeting, co-workers, or at church.
 I just want to sign the petition.

What is your goal?
I will collect signatures.

Who will likely be signing the petition?
 A group of voters residing in the same city or town.
 A group of voters residing in a two or three different cities or towns.
 A group of voters residing in several different cities or towns.


  • Dignity 2012
    PO Box 51700
    Boston, MA 02205

  • Phone: (617) 702-2012
  • Fax: (617) 507-6426
  • [email protected]