ABN: 53 975 273 862

Membership Form

Fields marked with a are required.

Member 1

Title

Surname

First Name

Middle Name

D.O.B

Member 2

NOTE: Only required if registering as a Couple

Title

Surname

First Name

Middle Name

D.O.B

Address

Lookup a Suburb/Town/City or Postcode

Address

Suburb

State

Postcode

Postal Address

Postal Address same as Address?

Lookup a Postal Suburb/Town/City or Postcode

Address

Suburb

State

Postcode

Email is the preferred contact method between Pauline Hanson's One Nation and its members. If you do not supply your email address, you will only receive important announcements from us via mail and not general party news.

Email Address

Occupation

Member 2 Email Address

Partner Occupation

Mobile Phone

Home Phone

Member 2 Mobile Phone

Declaration

Please tick YES or NO for all options

I/we believe in the values of Pauline Hanson's One Nation Party?

Yes

No

Have you ever been a member of another political party?

Yes

No

If Yes, which party?

Are you currently a member of another political party?

Yes

No

If Yes, which party?

Have you ever applied for, and been refused membership of another political party?

Yes

No

Have you ever been expelled from another political party?

Yes

No

Have you ever been nominated as a candidate in an election?

Yes

No

If Yes, please provide details

Register Member 1 as a Volunteer?

Register Member 2 as a Volunteer?

Membership Options

Membership will be for 12 months from date of approval by the relevant state, following receipt of the application form and membership fee in accordance with the constitution.

NOTE: Payment Plans can be arranged if you contact our office.

Membership Type

Membership Term

Membership Amount

Make a Donation?

OR Other Donation Amt

Property developers, their related bodies corporate and close associates (including directors and spouses of directors) and property development industry representative organisations are prohibited donors under state government legislation. By ticking this box, you certify to Pauline Hanson’s One Nation that you are not a prohibited donor. If you are in doubt about whether you are a prohibited donor, please contact Pauline Hanson’s One Nation before giving the party any donation, gift, or fundraising contribution. Further prohibited donation information can be found here.

I am NOT a prohibited donor

Total Invoice Amt
(includes GST)

Payment Options

Please select a payment method - options available are Credit Card and Paypal.

Payment Type

Total Amount

Reference

Card Type

Name on Card

Card Number

Expiry

3 Digit Security

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