Membership Application

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Membership Application

This is a secure membership application. Your information will be encrypted at all times while in transit.

Given Name: *

Surname: *

Date of Birth: *

Email:

Primary Phone: *

Secondary Phone:

Residential Address: *

Residential Suburb: *

Residential Postcode: *

Residential State: *

Postal Address:

Postal Suburb:

Postal Postcode:

Postal State:

I hereby apply to become a member of The WikiLeaks Party.
I declare that I am enrolled on the Commonwealth electoral roll at my address as shown above.
I declare that I am not a member of another party and agree not to join another political party whilst a member of The Wikileaks Party.
I declare that I will abide by the terms of the party constitution as published on the party website.
I am aware that it is a serious offence to make a false declaration.

I accept

If you experience any issues submitting your membership application, please email [email protected]

The membership fee is $20.00

Credit Card or Paypal payment of the membership fee can be made after clicking submit below. You will be sent a confirmation and receipt once your application has been processed.

EFT:
Bendigo Bank
Account name: WikiLeaks Party Ltd
BSB: 633 000
Account number: 149 364 713
(note your surname in the message field)

Cash, cheques or money order mailed to:
WikiLeaks Party
PO Box 434
Surry Hills
NSW 2010
(please include your name and address)

Membership Application