1 Start 2 Preview 3 Complete Application Form First Name * Last Name * Birth Date * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year19181919192019211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018 Electorate * - Select -- not found -Auckland CentralBay Of PlentyBotanyChristchurch CentralChristchurch EastClutha-SouthlandCoromandelDunedin NorthDunedin SouthEast CoastEast Coast BaysEpsomHamilton EastHamilton WestHauraki-Waikato (M)HelensvilleHunuaHutt SouthIkaroa - Rawhiti (M)IlamInvercargillKaikouraKelstonManaMangereManukau EastManurewaMaungakiekieMt AlbertMt RoskillNapierNelsonNew LynnNew PlymouthNorth ShoreNorthcoteNorthlandOhariuOtakiOverseasPakurangaPalmerston NorthPapakuraPort HillsRangitataRangitikeiRimutakaRodneyRongotaiRotoruaSelwynTamakiTamaki Makaurau (M)Taranaki-King CountryTaupoTaurangaTe AtatuTe Tai Hauauru (M)Te Tai Tokerau (M)Te Tai Tonga (M)TukitukiUpper HarbourWaiariki (M)WaikatoWaimakaririWairarapaWaitakereWaitakiWellington CentralWest Coast-TasmanWhanganuiWhangareiWigram Street Address * Street Address Line 2 * City * Phone Number * Email * Membership Type * - Select -Unwaged $2Waged $5Enthusiast $20 Signature Clear signature Membership is valid for three years. By submitting this application you agree to support the Cannabis Party’s policy and will help the party achieve its objectives in accordance with electoral law. You must be at least 18-years-old and eligible to vote in the next general election to join the Cannabis Party. Members will receive occasional emails from the party. Your details will be stored privately. _ _ _ _ _____ ___ | | __| | | | | | |__ / ( _ ) | | / _` | | | | | / / / _ \ | |___ | (_| | | |_| | / /_ | (_) | |_____| \__,_| \___/ /____| \___/ Enter the code above * Enter the code depicted in ASCII art style.
