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Party
Leadership 2022 – Intent to Vote Form
1
Certification
2
Personal Information
3
Donation
4
Billing Information
5
Payment Method
6
Credit Card Payment
Intent to Vote Form
There is no cost to vote for a candidate in the Leadership selection process.
All individuals who wish to vote in the Leadership process must complete an ‘Intent to Vote’ form. Submissions online and/or paper forms must be received by
4:30 pm on June 15, 2022.
Both new and current members of the provincial Liberal Party must submit a completed form. Members must be at least 14 years of age and a resident of New Brunswick by June 15, 2022.
Use of Personal Information
The office will use your personal information to create your unique NB Liberal Party profile in our membership database. This also allows the NBLA to confirm your eligibility to vote at the Leadership Convention.
Please note your membership profile will be shared with the Leadership candidates and you may be contacted during the campaign period.
Membership Requirement
You must be a member in good standing of the NBLA to participate in the Leadership process. If you are not currently a member, completion of this form signifies your intent to become a member of the New Brunswick Liberal Association and you will be automatically added to the Provincial Liberal Membership.
You may cancel your membership at any time by contacting the office at 506-453-3950 or toll free 1-800-442-4902 or info@nbliberal.ca.
Certification
You certify that the submitted information is correct, you are a resident of New Brunswick, you are at least 14 years of age, you do not belong to any other provincial political party, and you subscribe to the statement of values, principles and aims of the New Brunswick Liberal Association (NBLA) as set out in the Preamble of the NBLA Constitution.
*
I agree to all terms outlined above.
Note: If the form is not advancing to the next page after 10 seconds, you may need to clear the cache in your web browser. Alternatively, you can open an “Private”, ”Incognito”, or ”InPrivate” tab in your browser, and then go to nbliberal.ca and complete the form from there.
Name
*
First
Middle
Last
Address
*
Street Address
City
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Province
Postal Code
Date of Birth
*
We require your birth date for your membership profile.
Day
Month
Year
Gender
*
Female
Male
Other
You must provide at least one (1) valid phone number for your form to be processed. The phone number must be in this format (XXX)-XXX-XXX. DO NOT enter "1" before the area code.
*
I understand.
Mobile Phone
DO NOT put " 1 " before the area code. Number must be in this format: (XXX)-XXX-XXXX.
Home Phone
DO NOT put " 1 " before the area code. Number must be in this format: (XXX)-XXX-XXXX.
Which is your preferred phone number?
*
Home Phone
Mobile Phone
Email
*
A VALID EMAIL ADDRESS IS NECESSARY TO RECEIVE YOUR UNIQUE VOTING CREDENTIALS. ELECTORS CANNOT SHARE THE SAME EMAIL ADDRESS.
What is your preferred language?
*
English
French
Your provincial riding as of June 15, 2022
*
Restigouche West
Campbellton-Dalhousie
Restigouche-Chaleur
Bathurst West-Beresford
Bathurst East-Nepisiguit-Saint-Isidore
Caraquet
Shippagan-Lamèque-Miscou
Tracadie-Sheila
Miramichi Bay-Neguac
Miramichi
Southwest Miramichi-Bay du Vin
Kent North
Kent South
Shediac Bay-Dieppe
Shediac-Beaubassin-Cap-Pelé
Memramcook-Tantramar
Dieppe
Moncton East
Moncton Centre
Moncton South
Moncton Northwest
Moncton Southwest
Riverview
Albert
Gagetown-Petitcodiac
Sussex-Fundy-St. Martins
Hampton
Quispamsis
Rothesay
Saint John East
Portland-Simonds
Saint John Harbour
Saint John Lancaster
Kings Centre
Fundy-The Isles-Saint John West
Saint Croix
Oromocto-Lincoln-Fredericton
Fredericton-Grand Lake
New Maryland-Sunbury
Fredericton South
Fredericton North
Fredericton-York
Fredericton West-Hanwell
Carleton-York
Carleton
Carleton-Victoria
Victoria-La Vallée
Edmundston-Madawaska Centre
Madawaska Les Lacs-Edmundston
Please note the NBLA Admin will confirm your provincial riding.
Pitch in to support the NB Liberal Party's bright future!
*
Contribute to our 2022 fundraising efforts by sending along a donation with your registration.
Your donation may be eligible for a generous 2022 provincial tax credit. Thank you in advance!
Yes! I'd like to make a donation
Not right now.
Admin
This field is for office use only.
Please note: corporations, businesses and trade unions cannot make political contributions in New Brunswick as of June 1st, 2017. Please ensure that all donations, ticket purchases, and convention fees are made on behalf of an individual using only a personal credit card and/or personal cheque.
Frequency
*
Monthly
One-Time
This donation amount may be eligible for a provincial tax credit.
Price
$20
$50
$100
$500
Other Amount
Which riding would you like your donation to go to?
*
NBLA
Restigouche West
Campbellton-Dalhousie
Restigouche-Chaleur
Bathurst West-Beresford
Bathurst East-Nepisiguit-Saint-Isidore
Caraquet
Shippagan-Lamèque-Miscou
Tracadie-Sheila
Miramichi Bay-Neguac
Miramichi
Southwest Miramichi-Bay du Vin
Kent North
Kent South
Shediac Bay-Dieppe
Shediac-Beaubassin-Cap-Pelé
Memramcook-Tantramar
Dieppe
Moncton East
Moncton Centre
Moncton South
Moncton Northwest
Moncton Southwest
Riverview
Albert
Gagetown-Petitcodiac
Sussex-Fundy-St. Martins
Hampton
Quispamsis
Rothesay
Saint John East
Portland-Simonds
Saint John Harbour
Saint John Lancaster
Kings Centre
Fundy-The Isles-Saint John West
Saint Croix
Oromocto-Lincoln-Fredericton
Fredericton-Grand Lake
New Maryland-Sunbury
Fredericton South
Fredericton North
Fredericton-York
Fredericton West-Hanwell
Carleton-York
Carleton
Carleton-Victoria
Victoria-La Vallée
Edmundston-Madawaska Centre
Madawaska Les Lacs-Edmundston
Total
$ 0.00 CAD
Billing Address
Name
*
First
Last
Address
*
Street Address
City
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Province
Postal Code
Phone
*
Email Address
*
Personal Contribution
*
I am making this donation with my own personal credit card. No entity will reimburse me.
Your registration address must match the billing address for the credit card submitted below. If an error message or fraud alert is displayed, please review your previously entered information. If you need assistance, please contact the office at 506-453-3950 or toll-free 1-800-442-4902. If the office is closed, please leave a message and we will return your call. Thank you.
Total Amount:
$ 0.00 CAD
Credit Card
American Express
MasterCard
Visa
Supported Credit Cards: American Express, MasterCard, Visa
Card Number
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
Expiration Date
Security Code
Cardholder Name
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