3505 Porangahau Road
R.D. 4
Waipukurau, Central Hawkes Bay 4284
ph: 06 8555556
perfectg
THE ASSOCIATION OF SOVEREIGNZ PARTY
Membership Application form
Each individual must fill in and submit a separate form.
Gender ________________
First Name________________
Middle Name______________
Last Name_________________
Are you of Maori descent? ___
Ethnic Background__________
Physical Address as shown on the electoral role.
House Number and Street__________________
Suburb and City__________________________
Post Code_______________________________
Postal Address (if different) ________________
Home Phone____________________________
Mobile Phone___________________________
1st Email Address_________________________
Alternate Email Address___________________
I confirm that I am eligible to enrol as a New Zealand Parliamentary elector. Yes, or, no _____
I authorise The Association of Sovereignz Party to record my name as a financial member of the party. Yes, or, no____
I authorize The Association of Sovereignz party secretary to release this application form and membership details to the Electoral Commission for the purposes of obtaining party registratiom under the Electoral Act 1993. Yes, or, no____
CONDITIONS
You must revoke membership in any other political party before applying for membership in The Association of Sovereignz.
Membership subscription is $2.00, renewable every three years; payable to The Association of Sovereignz by cash, check, money order, or direct deposit to the Sovereignz bank account.
If making payment through internet banking or direct bank deposit, please ensure you list ‘membership’, first name, and last name with the deposit.
Deposit to the ‘Sovereignz’ Kiwibank Acct. No. 38-9019-0404698-00
Membership is provisional until payment is received, cleared, and approved by The Association of Sovereignz Executive Committee.
By submitting this application you agree to be bound by the rules and constitution of The Association of Sovereingz political party.
Signed by applicant ________________________________
Date of application (to be entered by the party secretary) _______
Copyright 2018 THE ASSOCIATION of SOVEREIGNZ. All rights reserved.
3505 Porangahau Road
R.D. 4
Waipukurau, Central Hawkes Bay 4284
ph: 06 8555556
perfectg