Membership Form (WA)

Name*
Prefix/Title First Middle Last
Name must appear exactly as it appears on the electoral roll, including your middle name. If you do not have a middle name, leave the middle field blank. You can check your details at https://check.aec.gov.au/ (opens in new window).
Your Prefix/Title*

This field is appearing as you have selected "Other Title" when entering your name.
Your preferred email address?*
Date of Birth*
Date of Birth information is required by the Electoral Commissions for verification purposes. You must be 18 or older.
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Age Check
Your Phone Number*

Mobile number is preferred.
Address*
Street Address City / Suburb Post Code Country

Please provide the address as recorded by the electoral commission. This is important as it supports the Party's ability to achieve and maintain state party status. Please check your enrollment at https://check.aec.gov.au/.
State / Territory*
State Electorate (Optional)
Optional. If you know your state electorate please insert it here.
Declaration*
- I have read the statement below
I am an Australian citizen and enrolled to vote. I am not relied upon by another party for the purposes of electoral registration. I hereby apply to join both the Federal and state Party as a Supporting Member. I understand that I may be contacted by the Federal and/or State Electoral Commission to verify my membership. I will abide by the constitution and associated regulations of the Parties.
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Next Membership Renewal Date
DD slash MM slash YYYY
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AEC Verified*
Assigned Membership ID
Member Mailout Reference Number
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Membership Type
Sorry, but it does not appear that you are 18 years old. You must be 18 or older to become a member of the party. You cannot submit this form.

This warning will also display if you have not yet entered a date of birth.

Membership Form (WA)

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