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___________________________

1^st 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 $10.00, 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) _______