GOLD PARTY

MEMBERSHIP APPLICATION FORM

NAME ________________________ __________________ ___________
                           last name                             first name           middle name                 

ADDRESS __________________________ _____________________________
                            street number                                  city, state, zip code    

Email address _____________________            Telephone number ___________________             

Dues paid (please circle)            1 cent            $10.00            $100.00            $1,000.00

Participation in Occupy Wall Street (or related event elsewhere):

Joined Gold Party at Occupy Wall Street site? _______

Regular or frequent participant? ________            Gold Party site coordinator? _________

Membership renewal ?            yes ________            no __________

Name of person taking application ____________________________________

Political preference/ party affiliation __________________________________

Comments _______________________________________________________

 

Membership in Gold Party does not preclude membership in another political party. It does not commit anyone to voting a certain way. There is no obligation to participate actively. However, the point system does reward individuals for their contribution in building up the party. Membership implies consent to the system of voting unless or until it is changed in a party convention. This system is for internal purposes only. Welcome to Gold Party. Help the movement grow.

 

SIGNATURE _________________________________    DATE ________________

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