MEMBERSHIP APPLICATION

Help End Marijuana Prohibition (HEMP) Party

 

Please print your details as they appears on the Electoral Roll and show all given names in full

Surname

 

 

 

Given Names

 

Residential Address

 

 

 

Suburb

 

 

 

State

 

 

Postcode

 

Date of Birth

 

 

 

Telephone (H)

 

 

Day               Month              Year           .   

Mobile

 

 

 

Email

 

 

 

 

Declaration

I wish to become a member of the HEMP Party,

 

I am eligible to enrol for Federal Elections,

(You are eligible to enrol for Federal Elections if:

 

·          you are 17 years of age; and

·          you are an Australian citizen; and

·          you have lived at your current address for at least the last month.)

 

(British subjects who are not Australian citizens are eligible to enrol for Federal elections if they were on the Commonwealth of Australia electoral roll on the 28th of January, 1984.)

 

I consent to this application form being forwarded to the Australian Electoral Commission in support of the Party’s application for registration. (Strike out if not applicable.)

 

I declare that all the information that I have supplied on this application form is true and complete.

 

Signature

 

Date

 

 

 

 

 

Please note: This form may be forwarded to the Australian Electoral Commission to confirm that the party meets the party registration requirements. The AEC conducts random surveys to verify membership and it is possible they may contact you asking you to confirm that you signed this form. This form will be treated by the AEC in strictest confidence. It will only be used to verify the party’s entitlement to registration and for no other purpose. The form is then returned to the party.

No copy or information contained in the form will be kept by the AEC.

 

HEMP PARTY USE ONLY

 

This is the annexure marked.                                                                     . referred to in the statutory declaration  

(annexure number) 

of .                                                                                                                                    .sworn

    (Name of person making declaration)                    .

the.                                .day of                                      (Month and year)

 

.                                                                                      .(Signature of person making declaration)

 

Before me:                                                                      (Signature of person before whom the declaration is made)