Membership Form

Help The Pirate Party Stay Registered

Thank you for helping us out by filling out this form, this form will auto-complete Elections Canada form EC 20360 (05/2013) and help us show Elections Canada that we meet their minimum mandate to maintain party status (250 qualified electors). By submitting this form you agree to the following conditions set by Elections Canada:

I confirm that I am a qualifed elector under the Canada Elections Act, i.e. I have attained the age of 18 years and I am a Canadian citizen. I am a member of the political party named above. I acknowledge that it is an offence under subsection 408(5) and paragraph 497.1(3)(f) of the Canada Elections Act to make a declaration that is false or misleading.

Title

Surname (Last Name)

Given name (First Name)

Middle Initial(s)

Birthday (I authorize Elections Canada to verify my name and address using my date of birth against the information in the National Register of Electors)

Preferred Language

Address (Elections Canada may contact you to verify the information provided in this declaration.)

Mailing Address (if different)

Signature Reset

After submitting this form, it will be saved on our servers and we will deliver it on your behalf to Elections Canada, if you see any problems you would like to correct simply fill this form out again using the same email address and it will overwrite your previous version. You may wish to save the following PDF for your own records.