NAME
	last name		first name		middle name or initial		suffix (if any)
ADDRESS
	street name and number		city or town		state	zip code	country
CONTACT
	main telephone number		email address		other telephone or fax
MENTOR /
RECRUITER	name of primary recruiter		party ID #		name of secondary recruiter		party ID #
			(if known)				(if known)
Are you a registered voter in U.S.A.?
(Check whichever applies.)			yes	no
DATE APPLIED
DUES PAID				Click here for further information about this form.
	I join Gold Party of my own free will, hoping to improve my country and the world.
SIGNATURE OF APPLICANT

Personal Information
		age		sex		race / ethnicity		occupation
Do you belong to another political party? Which one?
What political issues are important to you?
What about Gold Party interests you?
Have you musical, artistic, writing, or speaking talents?
Do you have a preference as to type of party activity?
Might you help organize a Gold Party group in your area?
Other comments or questions

Click here for further information about this form. 915 words

Print form from this website, fill in the blanks, and mail completed form, along with dues, to:
Gold Party, P.O. Box 3944, Minneapolis, MN 55403, U.S.A.

You will receive by return mail a confirmation of your Gold Party membership including your party identification number.