Flux (Formerly NVB) Founding Member Interest Form
Flux is an innovative political party intent on bringing democracy to the people. We believe the best way to govern is through sharing political power, and embracing specialisation.

This form indicates interest in becoming a founding member of the Flux political party (Full name: voteflux.org (Upgrade Democracy))

Results are not public as this contains moderately confidential info (like DoB)

Name (Full legal name)
Your answer
Are you an on the Australian Electoral Role
Email address
Your answer
Residential Address (as on electoral role)
Your answer
Date of Birth (required for AEC registration - put as today to withhold until necessary)
MM
/
DD
/
YYYY
Contact Number (Phone, will SMS first)
Your answer
Referred By (Optional)
The name of your referrer (or how you found out about us)
Your answer
Comments / Notes (Optional)
Anything you'd like to add, about yourself, us, or anything, really.
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Max Kaye. Report Abuse - Terms of Service - Additional Terms