The Fishing Party  (Queensland Branch)

 Membership No…………..  Fee Paid…$22……..  Receipt Number……....

 DECLARATION OF PARTY MEMBERSHIP

Parliamentary Electorates and Elections Act 1912

(Section 66D (2) (g1))  

I    (Print full name in BLOCK letters, as enrolled)

 

 

 

Of  (Insert place of living as appearing on the electoral roll)

 

                                                                                                                             

                                                                                                          Post Code:

 

 

Born  (Insert Date of Birth)

 

 

 Declare that I am a member of

 The Fishing Party (Qld)

 And I consent to that party relying on my membership for the purposes of the party qualifying for registration under the Parliamentary Electorates and Elections Act 1912.

 Signature of party member………………………………………..

 Dated this……………………………..day of…………………….200…..

 Note:             declaration of membership must be completed by (or at the direction of) the party member concerned and then signed by the member. Particulars to be completed are to be written by hand at the same time as the form is signed.

Each declaration of membership is to be made on a separate sheet of paper.

 The Electoral Commission may, I order to verify the requirements for registration of the party, request a person who signs a declaration of membership to confirm that the person is a member of the party and that person completed and signed the form

 PLEASE NOTE THIS FORM SHOULD BE RETURNED TO “THE SECRETARY . THE FISHING PARTY (Qld) PO BOX 1311.  AIRLIE BEACH Qld 4802  – NOT TO THE STATE ELECTORAL OFFICE