INTELLIGENT TRANSPORTATION SOCIETY (SINGAPORE)

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1 INTELLIGENT TRANSPORTATION SOCIETY (SINGAPORE) Membership no. C My Mailbox No , Singapore APPLICATION FORM FOR CORPORATE MEMBERSHIP Company name (as in Registry of Business, in block letters) Co./business registration no. Company address Internet URL Postal code: References Name of proposer #1 and membership no. Name of proposer #2 and membership no. Signature and date Signature and date I, on behalf of the abovenamed company/organization, hereby apply for election as Corporate Member of the Intelligent Transportation Society (Singapore). Upon being notified of my acceptance, I shall uphold and abide by the constitution, by-laws and regulations of the Society and that I shall accept as final and binding the decisions of the Council, and further that I am liable for annual subscription of $3000 # and that my membership does not commence until this amount has been received by the treasurer. Authorized signature and company stamp Name and designation Please mail together the complete set of application form (5 pages) a local cheque of $3000 payable to ITS (Singapore) one set of corporate brochure to the above address for your application to be processed. # Annual subscriptions for the subsequent years are due in May each year. 1/5

2 Corporate Profile Line of business (tick all that apply) Communications GPS/navigation/tracking Traveler information product/services Software developer/vendor System integrator Traffic monitoring and control systems/equipment Electronic payments, toll collection Freight and logistics Commercial vehicle and public transport operations Emergency management Vehicle or vehicle parts design/manufacturing/maintenance Parking and terminal operations Human factor related Transportation consulting services Infrastructure provider or material supplier Financial institution Other (please specify): No. of employees in Singapore involved in ITS-related activities: If your Singapore office a regional headquarter? *YES/NO Countries in which your Singapore office oversees or have ITS-related activities: Name and address of affiliated company overseas: *delete whichever not applicable 2/5

3 CORPORATE REPRESENTATIVE Full name (as in NRIC/passport, in block letters): Recent Designation address photograph Personal Particulars of birth (dd/mm/yyyy) NRIC/passport no. Nationality For non-singapore citizen, please state if Singapore PR: *YES/NO Education Polytechnic/college/university attended Course/program of study Qualification obtained Other Professional Qualifications, Memberships and Awards of election/award (mm/yy) Detail Abbreviation Experience Name of employer & address Position held Description of work 3/5

4 CORPORATE ALTERNATE REPRESENTATIVE Ffull name (as in NRIC/passport, in block letters): Recent Designation address photograph Personal Particulars of birth (dd/mm/yyyy) NRIC/passport no. Nationality For non-singapore citizen, please state if Singapore PR: *YES/NO Education Polytechnic/college/university attended Course/program of study Qualification obtained Other Professional Qualifications, Memberships and Awards of election/award (mm/yy) Detail Abbreviation Experience Name of employer & address Position held Description of work 4/5

5 FOR OFFICIAL USE ONLY Application received on: 1 st Annual subscription received $ Amount COUNCIL S DECISION Outcome of application Initial of Secretary Approved/Referred Back The Council, having considered the application and recommendation of Council Members, is satisfied that that applicant is eligible for election as Corporate Member of the Intelligent Transportation Society (Singapore), subject to provisions of the constitution, by-laws and regulations of the Society. Signature of President SECRETARIAT 1 Payment of fees to treasurer 2 Receipt no. 3 Commencement of membership on 4 Notification to applicant 5/5

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