Australia's Voice Membership Form
Please complete this form to become a member of Australia's Voice.
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Are you a member of another Political Party? *
What is your name as it appears on the Electoral Role? *
What is your street address (as it appears on the Electoral Role)? *
Suburb? *
State *
Postcode? *
Is your postal address different from your residential address? *
What is your postal address?
Contact phone number? *
What is your date of birth? *
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Membership is valued at $100, however if you are a concession holder or are having financial difficulties a reduced rate of $20 applies.  You do not have to provide evidence, and you can pay what you can afford.  How much can you pay for your membership? *
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