APPLICATION FOR PARTY MEMBERSHIP Name(Required) First Middle Last Address(Required) Street Address Address Line 2 City State Postcode Email(Required) PhoneFor which state are you listed on the electoral roll?Australian Capital TerritoryNew South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern AustraliaHave you been convicted of a disqualifying electoral offence in the last 10 years?(Required) Yes No Are you a member of another political party?(Required) Yes No If yes, please advise which party(Required) Please read and confirm the followingConstitution(Required) I have read and agree to be bound by the constitution of the party(Required)VEC Contact(Required) understand that my State Electoral Commission will contact me to verify my membership(Required)Membership(Required) I hereby apply for membership of the companions and pets party (note membership is free).(Required)True Information(Required) I acknowledge by submitting this form that the information I have provided is true and correct.(Required)I would like to show my support for the party by making a donation (this is optional) Yes No Amount(Required) Credit Card(Required)Card Details Cardholder Name CAPTCHA
