"*" indicates required fields Personal DetailsName* Mr.Mrs.Ms.Dr Prefix First Middle Last Date of Birth* DD slash MM slash YYYY Phone* Mobile* Email* Residential & Postal AddressResidential Address* Street Address City Australian Capital TerritoryNorthern TerritoryNew South WalesQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia State Postcode Postal Address* Same as residental address Street Address City Australian Capital TerritoryNorthern TerritoryNew South WalesQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia State Postcode Membership DetailsAre you on the electoral roll?* Yes No My main interest(s) are:* Shooting/Hunting Fishing Farming 4WD/Camping Other Select Membership Type* FULL Membership (1 Year) $30 PENSIONER Membership $20 Apply Family Discount 10% – only applies if you have other members of the SFFP in your immediate family 10% Family Discount* Price: $ 0.00 I would also like to donate: $5 $20 $50 $100 Other Custom donation amount Coupon Total Payable Authorisation and PaymentConsent* I acknowledge and agree that whilst I am a member of The SFFP WA Party, I will also be a member of the Federal Shooters and Fishers Party. The West Australian Electoral Commission may contact me to verify my membership.*Signature*Credit CardPlease check if you have activated a Stripe feed for your form. Please be advised, you may be contacted by the West Australian Electoral Commission to verify your enrollment.