GOLD PARTY
MEMBERSHIP APPLICATION FORM
NAME ________________________ __________________ ___________
last name first name middle name
ADDRESS __________________________ _________________________
street address city, state, zip code
Email address ____________________ Telephone number _______________
Dues paid (please circle) 1 cent $10.00 $50.00 $200.00 $500.00 $1,000.00 $5,000 other ______
Membership renewal ? yes ________ no __________
Designated sponsor (if any) ____________________________________
Political preference/ party affiliation __________________________________
Veteran? _______ Wounded veteran? _______
Comments _______________________________________________________
Membership in Gold Party does not preclude membership in another political party. It does not commit anyone to voting a certain way in elections. The point system used for voting in internal decisions rewards individuals for their contribution in building up the party. Welcome to Gold Party. Help the movement grow.
SIGNATURE _________________________________ DATE ________________
Send completed form plus membership dues to:
Gold Party
1702 Glenwood Avenue
Minneapolis, MN 55405
U.S.A.
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