Socialist Alliance Western Australia

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Please support our right to run in the March 2021 state election by filling out this form. In order to remain registered with the WA Electoral Commission so that we can stand candidates, we need at least 500 members.

There is no financial or other obligation of membership, but you must be on the electoral role in WA and may be contacted by the WA Electoral Commission to confirm your details. If they leave a message please respond.

If you filled out the form in the lead-up to the last election please do so again. This way we get confirmation of your continued support and you can update your address and other contact details if required.

If you would like to get active and become a financial member of Socialist Alliance National then please check the box at the bottom of this form.

For the billions, not the billionaires!

Surname (as on the electoral roll in WA) *

Given Names *

Date of Birth *

YYYY

Email address

Daytime phone *

Alternative phone

Residential address *

Please enter the address where you are registered with the Electoral Commission

I confirm that I am a member of Socialist Alliance WA, I consent to this form being forwarded to the WA Electoral Commission in support of the party's application and I declare that all the information I have given on this form to be true and complete. *

Yes

Required

I would like to be contacted about events

Yes

I would like to get active with Socialist Alliance

Yes

Submit

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