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Why Join Chifley Forum the Chifley Forum Offers You an Opportunity to Be Part of the Progressive Community Why Join Chifley Forum The Chifley Forum offers you an opportunity to be part of the progressive community. By joining the Chifley Forum, you will be invited to attend exclusive events where you can: Network with other progressive people in government, business and the community; Build relationships with current and future Labor leaders; and Discuss the issues that affect you with key Labor decision-makers. If you would like more information, please contact Ewan Whittle on Country [email protected] or (02) 9207 2000. CHIFLEY FORUM EVENTS LEADERS TREASURY SECRETARY END OF BRIEFING BRIEFING BRIEFING YEAR DRINKS Hon Bill Shorten MP Hon Chris Bowen MP Kaila Murnain Hon Kristina Keneally Leader of Shadow Treasurer General Secretary, Former Premier of the Opposition NSW Labor New South Wales Luke Foley MP Ryan Park MP Mark Morey Hon Bob Carr NSW Leader of the Opposition NSW Shadow Treasurer Secretary, Former Premier of NSW Shadow Minister NSW Shadow Minister Unions NSW New South Wales for Western Sydney for the Illawarra Hon Anthony Albanese MP Hon Tanya Plibersek MP Shadow Minister for Deputy Leader of the Opposition Infrastructure, Transport, Cities Shadow Minister for Education and Regional Development Shadow Minister for Women 2017 Shadow Minister for Tourism Chifley Forum Application Form GOLD DONOR ($1,000) 2 places to each of the 4 listed events and 1 Exclusive annual briefing – details to be provided upon joining PLUS a ‘Welcome Pack’ including a gold card and key ring SILVER DONOR ($500) 2 places to each of the 4 listed events and a ‘Welcome Pack’ including a silver card and key ring BRONZE DONOR ($250) 1 place to each of the 4 listed events and a ‘Welcome Pack’ including a bronze card and key ring How to join Chifley Forum 1 Choose your level of contribution by ticking the appropriate box below. 2 Complete your contact details. 3 Complete the payment section and sign the declaration. 4 Return the form to: Ewan Whittle, ALP NSW Branch, PO Box K408, Haymarket NSW 1240 or fax to (02) 9264 2574 or email [email protected] I am pleased to accept your invitation to join the Chifley Forum as a: Gold Donor for $1,000 (GST inclusive) OR 12 monthly payments of $80 Silver Donor for $500 (GST inclusive) OR 12 monthly payments of $40 Bronze Donor for $250 (GST inclusive) OR 12 monthly payments of $20 Chifley Forum fees and other contributions to the party are tax deductible. Your contact details: Name: ...................................................................................................................................................................................................................................................................................................................... Address: ............................................................................................................................................................................................................................................................................................................. ..........................................................................................................................................................................................Postcode: .............................................................................................................. Phone: ................................................................................ Fax: .................................................................................................. .............Mobile: ......................................................................... Email: ........................................................................................................................................................................................................................................................................................................................ PAYMENT – please tick the appropriate box Please send me an invoice Enclosed is my cheque for $ ......................... make payable to the Country Labor State Campaign ABN 94720463376 Monthly payment plan for $ ........................... per month from today and on the first business day of each month thereafter. (Please note payment must be received each month to confirm your membership.) Please debit my: Mastercard Visa Amex Diners for $ ............................................... Card Number: ....................................................................................................................................................................................................Expiry: .................. / ...................... Name on card: .............................................................................. Signature: ...........................................................Today’s date:. ............ /. .........../. ............ Please complete the following declaration: I authorise Country Labor to debit my credit card for the amount of my membership fees (for amount specified) and future membership fees as prescribed until further notice. All Chifley Forum donations are in support of the Country Labor State Campaign, and are paid into the Country Labor State Campaign Account. I certify that I am an individual on the electoral roll, and not on behalf of a corporation, union or other organisation. I authorise Country Labor to debit my credit card for the amount of my contribution (for the above amount) and future contribution fees. I confirm that this donation is not made by or on behalf of a ‘prohibited donor’ (being a ‘property developer’, ‘tobacco industry business entity’ or ‘liquor or gambling industry business entity’), or a ‘close associate’ of a ‘prohibited donor’, as defined in Division 4A of Part 6 of the Election Funding, Expenditure and Disclosures Act 1981 (NSW) Please Sign: Signature: .................................................................................................................................................................................................................... Date: .......... / ........../ ................ For further information please call Ewan Whittle on (02) 9207 2000. *Please note that Chifley Forum fees are treated as a donation towards the Country Labor State Campaign. The total deduction allowable in an income year is limited to $1,500. Members are required to disclose all donations over $1,000 in one financial year. .
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