Pauline Hanson's One Nation
Membership Application

Name_____________________________Phone (H)_______________Phone(W)_______________

     		                 FAX(H)_________________ FAX(W)_________________

Address:________________________________________________________________________

______________________________________________________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