New Membership

Administrative Details

•  
• Given Name(s)*
• Surname*
• Preferred Name(s)
• Date of Birth*
   
• Gender*
  • Male
    Female

Contact Details

•  
• Telephone Number (AH)
• Telephone Number (BH)
• Mobile Telephone
• Fax Number
• Email Address*
• Email Address (Alternate)

Residential Address

•  
• Street:*
• Suburb:*
• Postcode:*

Postal Address

(Enter if different to address above)

•  
• Street:
• Suburb:
• Postcode:

• Are you of Aboriginal or Torres Strait Islander descent?
• Do you wish to join Rainbow Labor?*
  • Yes
    No
• Would you like to receive all Labor correspondence electronically?*
  • Yes
    No

Declarations

Political Background & Electoral Enrolment Declaration

•  
• Have you been a member of any political party or prescribed organisation before (including ALP)?*
  • Yes
    No
• Party/Organisation/Branch
• Date of Joining
  Date and time
• Date of Cessation
  Date and time
• Have you been a candidate at Federal, State or Local Government level?*
  • Yes
    No
• If Yes, which Party and further details
• Are you enrolled to vote at elections at the residential address shown on this form?*
  • Yes
    No
• OR address enrolled at and why?
• OR reason I am not enrolled at all?

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 Institute of Marine & Power Engineers 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 (Federal Branch) HSUA Victoria No. 1 Branch HSUA Victoria No. 2 Branch (HACSU) HSUA Victoria No. 3 Branch (AHPA) HSUA Victoria No. 5 (HACSSA) Liquor, Hospitality & Miscellaneous Workers Union 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

Payment Details

(Full-year membership)

• New Membership Fee*
  • $33.00 (Concessional)
    $49.00 (less than $32,000 P.A.)
    $65.00 ($32,001 - $40,000 P.A.)
    $81.00 ($40,001 - $50,000 P.A.)
    $108.00 ($50,001 - $60,000 P.A.)
    $163.00 ($60,001 - $70,000 P.A.)
    $217.00 (more than $70,001 P.A.)
• Fee Amount $AUD
• Affiliated Union discount $AUD
• Other deductions $AUD
• Membership Total $AUD
• Concession Type
  • None
    Secondary Student
    Tertiary (Full-time) Student
    Centrelink Health Care Card
• Card Number
• Institution
• Your donation $AUD
• Would you like your membership renewed automatically each year via Credit card auto-debit?*
  • Yes
    No
• Payment Total $AUD