New Membership Page

Membership Form

"*" indicates required fields

Name*

Email*

Mobile Number*

Home Phone

Business Phone

Address*

Street Address Street Address Line 2 City State / Province / Region Post Code

Is your Postal Address the same as your Enrolled Address?*

Yes

Address

Street Address Street Address Line 2 City State / Province / Region Post Code

Date of Birth

Are you a member of another political party?

(If Yes, please resign from the other party before proceeding)

Yes

I apply for membership of the Australia’s Voice Party and agree to be subject to its rules*

If in Financial difficulties, please complete the following form instead: 'PAY LATER'

I agree

Membership*

Full Membership - 40 AUD

Concession Card Holders - 20 AUD

Total

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