Standard Membership

(One year subscription)

Your Details

Title

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First Name

Middle Name

Last Name

Date of Birth

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Input a valid email address

Phone

Residential Address (as per election roll)

Street

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Suburb

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Postcode

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State

My postal address is different to my residential address

Enter your full postal address

I would like to add my partner to this membership.

Partner's Title

Partner's Name

Partner's Date of Birth

Do you know any current Victorian National Party Members?

YES

Please name them here.

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Please tell us why you wish to join the party.

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Amount

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