Join the Australian Cyclists Party

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Last Name*
First Name*
Middle Name(s)
Email*
State*
Suburb*
Street Address*
Postcode*
Phone*	Mobile preferred
Date of Birth*	Must be in this format please: 28/04/1978 (As required by the Australian Electoral Commission).
Declaration*	I hereby apply to become a member of The Australian Cyclists Party I declare that I am not a member of another political party I declare that I am enrolled on the electoral roll at my address as shown above. I consent to my membership details being sent to the AEC or the relevant State Commission to support the party’s application for registration and to being contacted by the commission about my membership of this political party For NSW residents only: I have downloaded completed and signed the NSW Declaration of Party Membership form and have emailed it to: Angus@icycleivote.com Please tick all boxes to become a member of Australian Cyclists Party
Get more involved (optional)	Join mailing list to receive regular updates I'd like to join meetings and perhaps more I may be interested in standing as a candidate Select any options which suit you.