Australian Men's Party - Membership Application

Users of Netscape and compatible browsers can use the following form to apply online for membership. Applications must be confirmed in writing; the details below will be preprinted on a form which will be mailed out to you for your signature. You will be asked to declare that the information on the hardcopy form is true and complete, and send $5 membership fee.

If your browser cannot handle the online form, email us and we will send you a hard copy.

Required Information

Details marked in bold must be completed

Surname:

Given Names:

Known As (if different from first given name, eg. middle name, nickname, abbreviation):

Residential Address (the address where you are enrolled to vote, or intend to enrol to vote):

City/Suburb: State/Territory: Postcode:

Postal Address (if different from above):

City/Suburb: State/Territory: Postcode:

Telephone: daytime evening

Email:

I wish to become a member of the Australian Men's Party

I am eligible to enrol for federal elections:

(British subjects who are not Australian citizens are eligible to enrol for Federal elections if they were on a Commonwealth of Australia electoral roll on 25 January, 1984).

I consent to my details being forwarded to the Australian Electoral Commission in support of the party's application for registration

I have read and understood the Founding Principles of the Australian Men's Party, and am willing to commit to those principles

Other Information

What is your:

Federal Electorate (if known)

State Electorate (if known)

Local Government (if known)

Local Ward (if known)

What other political parties or organisations do you belong to?

Would you be willing to run as the Australian Men's Party candidate for:
(check as many as applicable)
Federal Senate State Senate Local Government Council
Federal House of Representatives State House of Representatives  

What else would you be willing to do for the party?
(check as many as applicable)
Recruit new members Attend rallies Deal with the media
Donate funds Staff polling booths Contact other parties and candidates
Raise funds Contribute to policy discussion Assist with the administration of the party
Serve as state, regional or local coordinator Attend branch meetings Distribute leaflets and other material
Campaign door-to-door in your area Address community groups Engage in public debates