Template Party Membership Form

Guidance notes

Application form to join the [Kiakoe]

Memberís details

Full name

Residential street address, suburb, town, city or locality [Not a PO Box address]

Date of birth


Telephone number/s

Email address

Enrolment details

I am a registered elector     YES/NO

enrolled in ____________________________ electorate

Complete if you are not a registered elector

I am not a registered elector but I am eligible to enrol     YES/NO

You are eligible to enrol if you are a New Zealand citizen or permanent resident of New Zealand, 18 years old or older and have resided in New Zealand continuously for one year or more and are not disqualified from enrolling. Contact the Electoral Commission if you are unsure whether you are eligible to enrol.

I am eligible to enrol as a New Zealand parliamentary elector as I am a (select one):

    New Zealand citizen
    permanent resident of New Zealand
    other Ė please specify: ­­­­­­­­­­­­­­______________________

and I have lived continuously in New Zealand for _______ years ________ months.

If you live overseas provide the date last in New Zealand ____ /____ /____

Membership details

I enclose/have paid my membership fee of $__.__ for a [1/2/3 year] membership with this application.

I authorise [Kiakoe] to record my name as a financial member of [Kiakoe].

I authorise the secretary of [Kiakoe] to release this application form and subsequent financial membership details to the Electoral Commission for the purposes of [Kiakoe] registration under the Electoral Act 1993.

Signed ____________________________ Date____________________