MEMBERSHIP REGISTRATION
Organisation / Company details
Name of company for publication in member list ………………………………………………………
ACN ……………………………………
Website ………………………………………….
Turnover* (Not for publication – only to assess membership classification and fees)
More than $100m
$50m - $100m
$0m - $50m
Local Govt & NFP
(fees $26,140 pa incl. GST)
(fees $15,680 pa incl. GST)
(fees $10,460 incl. GST)
(fees $5,230 incl. GST)
*Members self-assess their fees on an honour system. They are expected to have regard for their total corporate
turnover. In cases where a company also operates in areas which are clearly unrelated to roads, RA may be
prepared to accept an assessment based on a divisional turnover. Such cases should, however, be discussed with
RA and it is expected that the “benefit of the doubt” will be resolved in favour of the face value turnover.
Nominated Representative
Dr / Mr / Mrs / Ms….. ………………………
……………………………..
First Name
Title/Division
Email
Mobile
……………………………
.………………………….
.………………………….
Surname
Tel.
Tel.
Personal Asst. ….. ………………………
Switch ……………………..
Direct ……………………..
……………………………..
First Name
.………………………….
Email
Mail Address
Surname
Tel.
Direct ……………………..
…………………………………………………
………………………………………………...
Confirmation of Membership
Membership is governed by the Constitution of Roads Australia (RA) and the decisions made pursuant to it.
The Constitution and Privacy Policy may be found at www.roads.org.au.
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RA members respect the privacy of others in accordance with RA’s privacy policy and do not use
membership particulars for marketing purposes or release them to non-members. Information received at
meetings is also confidential to members.
Procedures may be declared at RA meetings in order to ensure compliance with ACCC legislation.
Membership fees are as determined by the Board.
Resignation of membership is to be given in writing at not less than six months’ notice.
I hereby apply for/renew membership of Roads Australia on behalf of the corporate entity detailed above.
Date ………………………
Signature ………………………………
(
)
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Chief Executive (if different from Nominated Representative)
From time to time RA holds functions specifically for the CEOs of member companies or invites them to speak at RA
Forums. Unless the CEO is the nominated representative he/she will not be contacted on routine RA business.
Dr / Mr / Ms / Ms….. ………………………
……………………………..
First Name
Surname
Personal Asst. ….. ………………………
……………………………..
First Name
Email
.…………………………...
Mailing Address
Surname
Tel. P.A…... ……………………..
…………………………………………………
………………………………………………...
………………………………………………..
State Representatives (please complete if applicable)
RA conducts general industry meetings and events in all state capitals. To achieve the full value of membership,
we encourage members to participate in the full range of RA activities.
State ………………
Dr / Mr / Ms / Mrs .. ……………………..
State …………....
Dr / Mr / Ms / Mrs ………………………..
First Name
First Name
.. ……………………..
………………………..
Surname
Surname
Title/Division
……………………………
Title/Division ……………………………..
Email
Tel.
.………………………….
.………………………….
Email
Tel.
State ………………
Dr / Mr / Ms / Mrs .. ……………………..
………. …………………….
………….………………….
State …………....
Dr / Mr / Ms / Mrs ………………………..
First Name
First Name
.. ……………………..
………………………..
Surname
Surname
Title/Division
……………………………
Title/Division ……………………………..
Email
Tel.
.………………………….
.………………………….
Email
Tel.
State ………………
Dr / Mr / Ms / Mrs .. ……………………..
………. …………………….
………….………………….
State …………....
Dr / Mr / Ms / Mrs ………………………..
First Name
First Name
.. ……………………..
………………………..
Surname
Surname
Title/Division
……………………………
Title/Division ……………………………..
Email
Tel.
.………………………….
.………………………….
Email
Tel.
………. …………………….
………….………………….
 Please return completed form to Lauren@roads.org.au
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