Sponsor Membership (single) Please call our office on (02) 9299 5811 if there are any problems processing this form. Step 1 of 3 33% Membership Details*Please select your membership optionSingle Sponsor Membership - $240Couples Sponsor Membership - $250I would like to include a donation to the NSW Nationals Preferred Branch (if known)Were you invited to join by someone? (Name)Are you a member of another political Organisation?*NoYesWhich Orginisation are you a member of?*Member 1 - Name (as appears on the Electoral Roll)* Mr.Mrs.MissMs.Dr.Prof.Rev.The Hon Prefix First Last Member 1 - Date of Birth* Date Format: MM slash DD slash YYYY Member 1 - PhoneMember 1 - Email* Member 2 - Name (as appears on the Electoral Roll)* Mrs.Mr.MissMs.Dr.Prof.Rev.The Hon Prefix First Last Member 2 - Date of Birth* Date Format: MM slash DD slash YYYY Member 2 - PhoneMember 2 - Email Are there any specific areas of policy you are interested in? Select All Health Education Agriculture & Water Economy & Jobs Roads & Infrastructure Energy & Environment Police & Emergency Services Community Services Total $ 0.00 Members Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Postal Address*As aboveIs different to residential addressPostal Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Total $ 0.00 Credit Card* Card Details Cardholder Name Is this a company credit card*NoYesCompany Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Company ABN*Total $ 0.00 IMPORTANT LEGAL INFORMATION I/We have read and understood the Party's Code of Conduct & Ethics and Harassment Policy and agree to abide by those policies and all other policies of the NSW Nationals. I hereby declare that I have read the below regulatory information and that I am legally permitted to make this donation. - Donations to Political Parties- There is a cap on political donations to the NSW Nationals. The cap is $6,600 for aggregated political donations to or for the benefit of a registered political party during the 2020/2021 financial year. This contribution is considered a donation to the NSW Nationals. From January 2020 it is illegal for any individual to donate over $100 in cash to any political party. - Prohibited Donors- Property developers, tobacco industry business entities, for-profit liquor or gambling business entities (including any industry representative organisation where the majority of its members are these entities) and their close associates are prohibited donors. A director or officer or person whose voting power is greater than 20% (and their spouses) are considered to be a close associate, as is a person in a joint venture or partnership with a property developer. Further, the spouse of a prohibited individual donor is a close associate. It is unlawful for a prohibited donor to make a political donation. If you make a donation and within 12 months become a property developer an amount that is double the amount or value of the donation will be payable to the State. - Disclosure Warning- If you make a political donation or incur electoral expenditure of $1,000 or more, you must complete and lodge a declaration with the NSW Electoral Commission in accordance with the Electoral Funding Act 2018 (NSW). A political donation includes a contribution or entry fee or an annual or other subscription. You must also disclose a political donation of less than $1,000 if the total amount of political donations made by you in respect of the same party (or associated parties), elected member, group, candidate or person in the same financial year is $1,000 or more. Penalties apply for failing to lodge a declaration. This includes small donations of $50 or less. - Further information- The above is a summary only. For the complete requirements, see Part 3 of the Electoral Funding Act 2018 (NSW).NameThis field is for validation purposes and should be left unchanged.