David Pollard Independent - party membership application
Support an Independent this election and join my party. Membership fee is optional, and there are no obligations - only what you want to do to help.

All details are confidential and are never passed to a 3rd party, except to Elections ACT to verify my membership count exceeds 100 members, after which they destroy their copy of the list. Your membership is private and will not be disclosed by me or my party.

More details: http://www.davidpollard.com.au/support/join-my-party/
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Email *
Given Names (including middle names) *
As on the electoral roll
Surname *
As on the electoral roll
Enrolled address *
As on the electoral roll
Postal address
If different from above
Date of birth
Not required but nice to have for electoral verification
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Membership type
Membership fee for financial members is tax deductible and will be processed once the party is registered
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Other political organisation memberships or affiliations
This will NOT disqualify you from joining my party
Comments
Optional - anything else you think I should know
A copy of your responses will be emailed to the address you provided.
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