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On line Membership Application Form

Note: The AEC has been invited to rule on the acceptability of this on line membership application form for the purposes of the AEC. Until advice of such a ruling has been received, please also submit a signed membership application via snail mail to PO Box 33, Richmond, QLD 4822.

Please complete the On Line Membership Application Form below. After clicking submit you will be taken to the Paypal Subscription page from where you may choose to select the appropriate Membership Subscription.

Note that all fields marked '*' are required fields.

Salutation: *
Surname: *
Christian name(s): *
(Please enter your name as you are enrolled on the electoral roll)

Does hereby make application for membership of Southern Cross Party Ltd.

I agree to comply with the Constitution of the Southern Cross Party Ltd and any Rules and By-laws which may be promulgated by the Southern Cross Party Ltd from time to time.

I acknowledge that this application for membership of the Southern Cross Party Ltd is an application to join the Southern Cross Party Ltd, the public company limited by guarantee AND the political party registered/to be registered pursuant to the Australian Electoral Commission (“AEC”) and the electoral commissions of the States and Territories of Australia and the State Party or Territory Party, if any, in the State or Territory in which I am domiciled as may be established at the date of this application or may be established at a later date.

I declare that as at the date of this application:

  1. I wish to become a Member of Southern Cross Party Ltd;
  2. I am not a member of any other political party registered in Australia;
  3. I have not been convicted of a disqualifying electoral offence within the last ten (10) years in Australia;
  4. I am eligible to enrol in the Federal Electorate of *
    and the State Electorate of *;
  5. All the information I/we have given on this form is true and complete.

I do not consent / I consent * to this form being forwarded to the relevant electoral commission in support of Southern Cross Party Ltd’s application for registration as a political party with the AEC and the electoral commissions in any State or Territory.

APPLICANT’S DETAILS:
Address line 1: *
Address line 2: *
State: *
Postcode: *
Postal address (if different from above):
Postal Address line 1:
Postal Address line 2:
Postal State:
Postal Postcode:
Telephone number: *
Facsimile number:
Mobile number:
E-mail address: *
Date of Birth: * DD/MM/YYYY
Occupation: *
Branch: *
Please indicate your preferred Branch:
MEMBERSHIP FEES:
I tender my Subscription Fee by: *

cheque made payable to 'Southern Cross Party Ltd',
      mailed to P.O. Box 33, Richmond Qld 4822

direct deposit to Account Name 'Southern Cross Party Ltd',
      Account Number 873 481 026, BSB 084-714, or by

Paypal Subscription (select on next page)

including GST, for Membership type: *

Foundation Member (First Year FREE)
Ordinary Member ($55.00)
Ordinary Member (student) ($22.00)
Ordinary Member (joint - 2 people) ** ($88.00)
Ordinary Member (pensioner) ($11.00)
Ordinary Member (fully-paid) ($550.00)

** A joint member is required to complete a separate Application for Membership form to be attached to this form.

You may also make a Donation using the box on the left.
(Donations over $100 are tax deductible)
Additional message:  
Date of application: * DD/MM/YYYY
Signed name: *
You must complete and click in the 'Signed name' field to enable the 'Submit' button.

PLEASE NOTE: Southern Cross Party Ltd may send this form to either the AEC or State or Territory electoral commissions to confirm that Southern Cross Party Ltd meets the relevant party registration requirements.

The AEC conducts random surveys to verify Membership and it is possible that they may contact you asking you to confirm that you are a Member and signed this form. The 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 will then be returned to the party. No copy of the form will be kept by the AEC.

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.

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