Membership Information You have selected the Personal membership level. Applies to all those committed to improving road safety $220 (inc GST) $200 for overseas members If you are a renewing member, please review the details below to ensure all information is up to date and correct. Do you have a discount code? Click here to enter your discount code Discount Code Account Information Username Password Show Password Confirm Password First Name Last Name Email Address Confirm Email Address Full Name LEAVE THIS BLANK Already have an account? Log in here Individual Information Primary Phone Secondary Phone What Chapter would you like to join? Please Select Australian Capital Territory & Region New South Wales Queensland South Australia Tasmania Victoria Western Australia New Zealand International Postal Address Line 1 Postal Address Line 2 Postal City State Postcode Country Australia Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Austria Azerbaijan Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Chad Chile China Colombia Comoros Congo (Congo-Brazzaville) Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czechia (Czech Republic) Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini (Swaziland) Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Myanmar (Burma) Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria North Korea North Macedonia Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Korea South Sudan Spain Sri Lanka Sudan Suriname Sweden Switzerland Syria Tajikistan Tanzania Thailand Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Yemen Zambia Zimbabwe Company Name What is your Organisation Sector? Please Select Emergency Services - Other Emergency Services - Police Advocacy - Road Safety Advocacy - Vehicle Safety Advocacy - Other Education - Driving School/Instructor Association Education - University Education - Other Government - National Government - Local Government - State/Territory Research - Medical Research - Road Safety Agency Research - Vehicle/Road Testing Research - Other Health and Medical Private Consultant/Company - Engineering Private Consultant/Company - Industry/Manufacturing Private Consultant/Company - Road Safety Private Consultant/Company - Insurance Private Consultant/Company - Other Interested Member of the Public Other - Funding Other - Not Specified What made you join ACRS? Please Select Belief in the cause Referred by colleague/friend Relevant to profession Conference discount Extra Information Title e.g. Dr/Prof/Ms/Mr/Mx Job Position Company Do you identify as First Nations or Indigenous? Please Select Yes No Prefer not to say What is your age bracket? Please Select 18-24 25-40 41-60 61-69 70+ Prefer not to say What is your gender? Please Select Woman Man Non-Binary/Indeterminant Prefer not to say What is your highest level of education? Please Select PhD Masters Graduate Certificate Bachelors Diploma TAFE Certificate Year 12 Prefer not to say What is your area of expertise? Subscribe to the Weekly Alert Yes No Subscribe to the Journal Yes No Subscribe to Conference emails Yes No Would you like to join the LGN? Yes No (Local Government Network) Would you like to join the IOC? Yes No (International Outreach Chapter) Would you like to join the ECN? Yes No (Early Career Network) Would you like to join the WiRSN? Yes No (Women in Road Safety Network) Would you like to join the RPN? Yes No (Road Policing Network) Choose Your Payment Method Pay by Credit Card Pay by EFT or Direct Deposit Payment Information Card Number Expiration Date CVC Discount Code Pay by EFT or Direct Deposit ACRS bank details for EFT transfers: Bank: Bendigo Bank BSB: 633 000 ACC: 157 497 900 Please note a 2% fee is added to all card payments over $250. I agree to the Membership Policy Processing...
