Application for membership of the Community Alliance Party (ACT)

 

First name:

Surname:

Address:

Phone: Mobile:

Email:

I declare that I am not a member of any political party.

I am / am not * enrolled as an ACT voter
delete as applicable

The above details are true and correct. If accepted as a member of the Community Alliance Party, I will support its objectives, assist its candidates and abide by its rules and Constitution.

I enclose my membership application fee of $20.

Signed:

Date:

 

return to
Caroline Ambrus
6 Casey Cr., Calwell, ACT 2905

 

email: cambrus@iinet.net.au

enquiries 62921192