* Strike out inapplicable items where indicated

As an elected member of the Senate / House of Representatives*, I pledge that I will vote for the Simultaneous Policy (SP) to be implemented when the governments of all, or sufficient, nations have likewise pledged to implement it (hereafter the "SP Pledge"), and I will encourage members of my party to join this effort.

I understand that the SP Pledge is provisional at this stage since the policy content of SP is yet to be decided by citizen-adopters of SP world-wide under the auspices of the International Simultaneous Policy Organisation (ISPO). I further understand that the SP Pledge applies to SP as an integral and indivisible package of policy measures.

If I wish to cancel my pledge, I will notify the Australian Simultaneous Policy organisation, Simpol-Australia, in writing.

I understand that Simpol-Australia and the International Simultaneous Policy Organisation will make my SP Pledge -- and any cancellation of that pledge -- known publicly, and particularly to SP Adopters, in my electorate and/or region.

I am making this pledge in my own name (not that of my party as a whole )¹.

Name (block capitals): ………………………………………………………………

Party: ……………………………… Electorate …………………… State………...

(Electorate) Address: …………………………………………………………………

………………………………………………………………………………………

Telephone number: ………………………………………………………

Email: …………………………………………………………………………………

Date: ………………………………………

Signature: ………………………………….…………….…………….

¹The party as a whole can pledge to support SP using a different procedure

Please return this form to:

Simpol Australia, PO Box 637, Rockingham City WA 6168

Simultaneous Policy: Using Our Votes to Take Back the World

Contact details will be held by SP organisers only and will not be published or passed to third parties without prior permission, unless already publicly available.

Authorised and printed by Brian Jenkins, 12 San Domingo Close, Safety Bay 6169 for Simpol Australia

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