Renew Your Membership Please complete the form below to renew your membership. Membership Fee * Ordinary (Full) Member - $ 80.00 Ordinary (Full) Member - Concession - $ 40.00 Donation Add an optional donation to your membership Total Amount Member Details First Name * Middle Name Last Name * Electoral Status * Yes No Silent Elector Are you on the Australian electoral roll? Email * Birth Date Landline Mobile Phone Residential Address Street Address * Address Line 2 City, Town or Suburb * Country * - select - Australia State * - select - Australian Capital Territory New South Wales Northern Territory Queensland South Australia Tasmania Victoria Western Australia Postal Code * I wish to join the following advocacy groups Advocacy Groups Country Democrats Are you a member of another political party? Member of Another Party * Yes No Declaration Declaration * Yes I consent to being a member of the Australian Democrats and agree to comply with the Constitution of the Australian Democrats Credit Card Card Type - select - Visa MasterCard Amex Discover Card Number * Security Code * Expiration Date * -month- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec -year- 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 My billing address is the same as above Billing Name and Address Billing First Name * Billing Middle Name Billing Last Name * Street Address * City * Country * - select - Australia State/Province - none - Australian Capital Territory New South Wales Northern Territory Queensland South Australia Tasmania Victoria Western Australia Postal Code *
