Membership Information You have selected the Corporate Platinum membership level. The price for membership is $21,650.00. Customers in Australia will be charged a 10% GST. Membership expires after 12 Months. 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 Corporate Information You have selected a corporate membership level. Please enter the information below on behalf of the Main Contact, and once payment has been made you will be able to login and add staff to the membership. Primary Phone Secondary Phone Company Name Chapter Please Select Australian Capital Territory & Region New South Wales Queensland South Australia Tasmania Victoria Western Australia New Zealand International Company Postal Address Line 1 Company Postal Address Line 2 Company Postal City Company State Company Postcode Company Country Company Website Link Company Website Logo 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 Journal Yes No Subscribe to the Weekly Alert Yes No Subscribe to Conference emails Yes No Would you like to join the LGN? Please Select Yes No (Local Government Network) Would you like to join the IOC? Please Select Yes No (International Outreach Chapter) Would you like to join the ECN? Please Select Yes No (Early Career Network) Would you like to join the WiRSN? Please Select Yes No (Women in Road Safety Network) Would you like to join the RPN? Please Select Yes No (Road Policing Network) testwithplease select Please Select Yes No testwithoutselect Yes No testwithoutselectdefault Australian Residents Check this box if your billing address is in Australia. 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...