Join Victorian Labor Have your say in Victoria’s future. Join Victorian Labor today by completing the details below. For information on local branches in your area, please email firstname.lastname@example.org. Administrative Details Fields marked with * are mandatory. Given Name(s) * Last Name * Preferred Name(s) Date of Birth (DD/MM/YYYY) *minimum age of 14 years old Gender * Male Female Not Specified Contact Details Email * Email (alternate) Mobile Number * Phone Number (AH) Phone Number (BH) Fax Number Are you of Aboriginal or Torres Strait Islander descent? No Yes Do you wish to join Rainbow Labor? No Yes Do you wish to join Labor for an Australian Republic? No Yes Would you like to receive all Labor correspondence electronically? No Yes Residential Address Street * Suburb * Postcode * Postal Address Only required if different from residential address Street Suburb Postcode Declarations Political Background & Electoral Enrolment Declaration Have you been a member of any political party or proscribed organisation before (including ALP)? * NULL No Yes Party/Organisation/Branch * Year of Joining * Year of Cessation * Have you been a candidate at Federal, State or Local Government level? * NULL No Yes Which Party and details? * Are you enrolled to vote at elections at the residential address shown on this form?* NULL No Yes Reason not enrolled at this address? * Union Membership Declaration Affiliated Union members are eligible for a $5 discount off membership costs Occupation(s) Union & Division No Union Affiliation AMWU Metals Division AMWU Printing Division AMWU Vehicle Division ASU Victorian Authorities and Services Branch ASU Victorian Private Sector Branch Australasian Meat Industry Employees Union Australian Workers Union Blind Workers Union CEPU Comms. Division P&T Group CEPU Comms. Divison T&S Group CEPU Plumbing Division CFMEU Construction & General Division CFMEU F&FPD CFMEU F&FPD No. 7 Branch (Pulp & Paper) CPSU – PSU Group Finance Sector Union Health Workers Union HSUA Victoria No. 2 Branch (HACSU) Maritime Union of Australia NUW - Victorian Branch Rail, Tram & Bus Union Shop Distributive & Allied Employees' Association Textile, Clothing & Footwear Union of Australia Transport Workers Union United Firefighters Union United Voice Non-affiliated Union Payment Details Prices are for a 6 month membership. Please note that the Victorian ALP Rules require a member to pay for their own membership except that a member may authorise another family member living in the same household to pay their membership. New Membership Fee $15.00 (concession) $25.00 ($40,00 and under P.A) $47.50 ($40,001-$70,000 P.A) $112.50 ($70,001 and above P.A) Concession Type * PLEASE SELECT Secondary Student Tertiary (Full-time) Student Centrelink Health Care Card Concession/Student Card Number * Fee Amount Affiliated Union Discount Membership Total Donation Payment Total I hereby pledge myself to the Australian Labor Party to faithfully uphold to the best of my ability its Constitution and Platforms and to work and vote for the selected Labor candidates. I am not a member of any other organisation which pledges its members to support candidates for public office. I will forfeit my membership if I nominate against any endorsed Labor candidate. If I employ labour, I will actively encourage trade union membership.* Please make sure all fields are filled out correctly.