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| Not sure which option? Check the Gore-a-metre: |
| $100 1 minute of air time maximum on the show, possibly during credits or before or after a add-break. WARNING You most likely will survive. |
| $1000 Your name mentioned and other points about you, plus possible news item possibility. WARNING You may survive. |
| $10,000 Main item on the show and definate mention on international news. |
| Male |
| Female |
| METHOD OF PAYMENT |
| Will |
| Mastercard |
| AUCTION OF WEAPON? |
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| Cash |
| Yes |
| No |
| If so which charity benefits^: |
| Suicide Prevention |
| House with no steps |
| St Vincent DePaul |
| ^ 50% Charge for Cleaning, 10% Charge for in studio moving, 10% Charge for Display cleaning 10% Charge for Presenters Tupee Fund, 5% Charge for moving outside of studio, 5% Charge for Display Lighting, 8% Charge for Postage and Handling of Cheque for Charity, 1% Charge for Fancy Envelope with Random Death logo, Basically leaving 1% for Charity. |
| If you dont allow others will think your a total tightarse. |
| A RANDOM DEATH FUNERAL? |
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| Official Random Death Gravestone |
| Official Random Death Casket |
| Special Guests including > Andrew Daddo > Some Neighbours Chick > and The Zoom Zoom Kid from Mazda |
| Full Name |
| Address |
| Place of Work or School |
