Membership Application
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Member Information (Please add all information on Electoral Roll)
Title
Mr.
Mrs.
Miss
Mstr
Dr.
Prof.
Sir
Rev
Name (if no middle name, type 'none')
*
First
Middle
Last
Preferred First Name
*
Birthdate
*
Sex
Male
Female
Occupation
*
Electoral Address Membership
Contact Email
*
Mobile
*
Electoral Roll Address
*
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
Membership Details
Reasons for Joining Trumpet of Patriots
*
Referred By (if applicable)
First
Last
Confirmation
Agreement
*
I agree to Trumpet of Patriots’ rules and code of conduct. I understand that failure to follow party rules may result in termination from the party.
Date of Application
*
Join
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