membership DL form.indd - Labour Party

JOIN THE LABOUR PARTY
New member Renewal of membership
Your electorate (if known)
Today’s date
Subscription - please tick
Waged $15.00
Unwaged $6.60
Family 1 $20.00
Century Fund 2 $10.00 / mth
Income related - please tick
$20,000 - $30,000 $25.00
$30,000 - $45,000 $35.00
$45,000 + $60.00
1
Two or more people over the age of 15 who live together and belong to the same branch.
Please include the names and contact details of all family members when you return this form.
2
This ongoing contribution will automatically renew your membership each year while also
helping to fund your local organisation and Labour Party election campaigns.
Total
$
DONATE TO THE LABOUR PARTY
YOUR CREDIT CARD DETAILS
I pledge to observe the Labour Party Constitution
✘
It’s not necessary to join the Labour Party in order to donate.
Donation Subscription Total
Visa / Mastercard American Express Diners
Name on card
+
$ $ $
Signature
✘
=
Card number
Expiry date
YOUR PERSONAL DETAILS
Title
First name(s)
Surname
Address(es)
Phone numbers
Home:
Mobile:
Email address
Date of birth
Please return your completed form to: Labour Party, PO Box 784, Wellington.
For more information phone 0800 4 LABOUR or visit www.labour.org.nz

“I believe that together
we can achieve more. With
hard work, inspiration and with
fierce belief in ourselves as
New Zealanders.”
PHIL GOFF
Leader of the Labour Party