CLAIRE HOLLEY West Coast-Tasman

                   



Application Form to Join GOdsownNZ (Political Party)

(Please print and fill out)

Member’s details (If you are joining as a couple, you may use the same form)

Full name/s

Residential street address 

Suburb, town, city or locality [not a PO Box address]

Date/s of birth

Telephone number/s

Email address/es 

Enrolment details

I am/we are registered elector/s  YES/NO

enrolled in  ____________________________    electorate.

Complete if you are NOT a registered elector 

I am/we are not a registered elector/s but I am/we are eligible to enrol   YES/NO 

You are eligible to enrol if you are a New Zealand citizen or permanent resident of New Zealand, 18 years old or older and have resided in New Zealand continuously for one year or more and are not disqualified from enrolling. Contact the Electoral Commission if you are unsure whether you are eligible to enrol.

I am/we are eligible to enrol as a New Zealand parliamentary elector as I am/we are a (select one):   

  • New Zealand citizen
  • permanent resident of New Zealand
  • other – please specify: ______________________

and I/we have lived continuously in New Zealand for _______ years ________ months. 

If you live overseas provide the date last in New Zealand  ____ /____ /____

Payment Details

I/we enclose/have paid (date________)(Direct Credit details below) my/our membership fee of $                         for a 3 Year membership with this application. 

Circle:$10 Unwaged/Student $15 Individual $20 Couple. Donations gratefully received! ($_____)

Direct Credit (Sorry no Credit Card payment facility):

Bank: Kiwi Bank     Account Name: GOdsownNZ   Bank AC NO.: 38-9018-0391442-00                                               

I authorise GOdsownNZ to record my name as a financial member of GOdsownNZ party.

I/we authorise the secretary of GOdsownNZ to release this application form and subsequent financial membership details to the Electoral Commission for the purposes of (Name/s)___________________________________’s registration under the Electoral Act 1993.

Signed (both, if a couple) ________________________________________ Date ______________

Please return to: GOdsownNZ, P.O. Box 441, Greymouth, N.Z. 7805. 

Your Membership Card will be sent to you on receipt of your payment. Thank You!