To join the PEPA please print off and complete the Membership Form below and send it to the address on the Form, PO Box 54, Beelbangera 2680. (Phone: 0429 782 499)
It is absolutely essential that all details requested on the Application Form are accurate and complete. This is needed for registration of the Party and for placement on the Ballot Papers at any election.
You can choose to send your Membership Fee with the Form (preferably by crossed cheque), OR
pay the $10 Membership Fee directly to the PEPA account at the National Australia Bank, Griffith, NSW (Information on the form).
PUBLIC EDUCATION PARTY OF AUSTRALIA (PEPA) PARTY MEMBERSHIP FORM
Member’s details
Full Name (First Name)_________________ (Surname)_______________________
Residential Address _________________________________________
Suburb/Town ___________________________ State _____ Postcode ________
Postal Address ________________________ Suburb/Town _________________ State _____ Postcode _______
Daytime Telephone ( )__________ After hours( ) ________Mobile _____________
Date of Birth ____/____/______ Email address __________________________
I hereby apply to become a member of the Public Education Party of Australia .
Please cross out two of the following items:
I declare that I am enrolled on the Commonwealth Electoral Roll
Or
I have attached to this Form an explanation of why I am not currently enrolled with the details shown above.
Or
I am not entitled to be on the Commonwealth electoral.
Applicant’s Signature_______________________________________
_______________________________________________________________________________________________________
• I declare that I will abide by the terms of the Party Charter and Constitution as published on the party website.
• I consent to my membership details being sent to the AEC to support the Party’s application for registration and to being contacted by the AEC about my membership of this political party.
• I am aware that it is a serious offence to make a false declaration.
Member’s signature:_____________________________
Please mail this Form to: The Treasurer, PEPA, Box 54, PO Beelbangera 2680.
The Membership Fee ($10) may be sent with the Form, OR
Direct Deposited to the PEPA’s Bank Account at the NAB Griffith: BSB 082-632 Account #14-735-1198.
Public Education Party of Australia 