Pauline Hanson's One Nation
Membership Application

Name_____________________________Phone (H)_______________Phone(W)_______________

     		                 FAX(H)_________________ FAX(W)_________________


______________________________________________________Post Code_________________

Do you have any special talents/skills that will help the movement (fundraising,
typing, corporate contacts, media contacts, election campaign experience?)

(Optional) What political party have you previously supported? _______________

Membership Fees per annum: Single $40.00 Couple $50.00 Pensioner and self-funded Retiree - Single $20.00 Couple $25.00 pa. If you can further assist the cause, please include a donation to help Pauline Hanson's ONE NATION fight an election campaign against well funded opponents. My special donation to support Pauline Hanson's ONE NATION $___________
Make cheques payable to Pauline Hanson's ONE NATION or charge my credit card: Bankcard Visa Mastercard AMEX Diners Amount $_______________ Number_________________________ Expiry Date____________ Name of Card Holder_____________________________Signature______________________ Please list anyone who would be interested in receiving a membership application. 1 Name_____________________________Phone__________________Fax__________________ Address_________________________________________________Post Code____________ 2 Name_____________________________Phone__________________Fax__________________ Address_________________________________________________Post Code____________ 3 Name_____________________________Phone__________________Fax__________________ Address_________________________________________________Post Code____________
Please return to: Pauline Hanson's ONE NATION - PO Box 2000 Manly 2095 pf fax to 02 9976 0285
Further information:- Phone 02 9976 0283 or 02 9976 0284