(v.2017)

International Co-operation
on Theories and Concepts in Traffic Safety

APPLICATION FORM for

(double click on the cell and select “activated” to mark the chosen one)

PERSONAL MEMBER or INSTITUTIONAL MEMBER

Mr. Ms. / Forename:
Family name:
E-mail:
Organisation:
Fiscal or VAT code (personal or from Institution):
Fiscal address:
Postal code: / City:
Country:
Phone: / Fax:

Only in case of institutional members:

Name of financial responsible (case of institutions)
E-mail of financial officer (to send invoices):

Note: the above details should correspond to which have to appear in the invoice (especially for institutional members). Invoices are always sent by e-mail (as “pdf“ file, blocked against modification to preserve its condition of original).

The membership fees are as follows, according to the World Bank Categories (see next page).

Membership fee will be charged according to the living/working place of the applicant!

Please confirm condition marking the corresponding cell in the table (double click on the cell and activate it).

One unique payment per year of / Cat. A / Cat. B / Cat. C / Cat. D
Personal member / 150 € / 75 € / 40 € / 20 € *
Institutional member / 680 € / 340 € / 170 € / 85 €

New members from countries C&D can pay 5 years in a unique payment in the moment of filling this form.

Payment modality: Transfer In-Hand Other: (subject to acceptation)

IF TRANSFER, please, to the following account: / IF IN HAND please provide the following information:
Bank: SANTANDER.C.H.
Address: Av. Blasco Ibanyez, s/n
E-46010-VALENCIA
IBAN: ES84 0049 6721 6828 1001 6622
BIC/Swift: BSCHESMMXXX
Holder: Hector Monterde i Bort – ICTCT
Gral.Account
è BE SURE THAT YOUR NAME APPEARS IN THE VOUCHER / Amount
delivered: Currency:
This amount is: Full payment or Partial (in advance) or Other cases (subject to acceptation).
If “in advance” please send the rest by bank transfer a.s.a.p.
Name and signature of the member who receives the money on behalf ICTCT:

I/we declare the wish to be member of ICTCT, accepting the Statutes and Rules of ICTCT.

Signature of the applicant member

or representative of the Institution: Date:

* given that the member submits an annual activity report

- Student-members pay 50 % of the corresponding amounts

-  A newcomer has the right to pay the next year membership fee on the spot of a regular workshop, while (s)he can enjoy a reduction also on this year’s registration fee

-  All participants of a member organisation benefit from a reduced workshop fee and each member organisation has three votes at the general assembly

-  If you change to a country in a different category, please inform to the Secretary

For an occasional reduction of the membership fee please contact the secretary of ICTCT.

In order to pay your membership fee you will receive a letter with an invoice from the cashier after you have sent your application form to the secretary.

You are kindly requested to visit our web-site: www.ictct.org or http://www.adcomp.hu/ictct/, to read the Statutes and Rules of ICTCT.

The World Bank categorises most countries of the world according to income as follows:

World Bank Economic Categories

Category A: High-income countries

Category B: Upper-middle income countries

Category C: Lower-middle income countries

Category D: Low income countries

Country Category A

Andorra, Aruba, Australia, Austria, Bahamas, The, Bahrain, Barbados, Belgium, Bermuda, Brunei Darussalam, Canada, Cayman Islands, Channel Islands, Croatia, Curaçao, Cyprus, Czech Republic, Denmark, Equatorial Guinea, Estonia, Faeroe Islands, Finland, France, French Polynesia, Germany, Gibraltar, Greece, Greenland, Guam, Hong Kong SAR, China, Hungary, Iceland, Ireland, Isle of Man, Israel, Italy, Japan, Korea, Rep., Kuwait, Liechtenstein, Luxembourg, Macao SAR, China, Malta, Monaco, Netherlands, New Caledonia, New Zealand, Northern Mariana Islands, Norway, Oman, Poland, Portugal, Puerto Rico, Qatar, San Marino, Saudi Arabia, Singapore, Sint Maarten (Dutch part), Slovak Republic, Slovenia, Spain, St. Martin (French part), Sweden, Switzerland, Trinidad and Tobago, Turks and Caicos Islands, United Arab Emirates, United Kingdom, United States of America, Virgin Islands (U.S.).

Country Category B

Albania, Algeria, American Samoa, Antigua and Barbuda, Argentina, Azerbaijan, Belarus, Bosnia and Herzegovina, Botswana, Brazil, Bulgaria, Chile, China, Colombia, Costa Rica, Cuba, Dominica, Dominican Republic, Ecuador, Gabon, Grenada, Iran Islamic Rep., Jamaica, Jordan, Kazakhstan, Latvia, Lebanon, Libya, Lithuania, Macedonia FYR, Malaysia, Maldives, Mauritius, Mayotte, Mexico, Montenegro, Namibia, Palau, Panama, Peru, Romania, Russian Federation, Serbia, Seychelles, South Africa, St. Kitts and Nevis, St. Lucia, St. Vincent and the Grenadines, Suriname, Thailand, Tunisia, Turkey, Uruguay, Venezuela RB.

Country Category C

Angola, Armenia, Belize, Bhutan, Bolivia, Cameroon, Cape Verde, Congo Rep., Côte d'Ivoire, Djibouti, Egypt Arab Rep., El Salvador, Fiji, Georgia, Ghana, Guatemala, Guyana, Honduras, India, Indonesia, Iraq, Kiribati, Kosovo, Lao PDR, Lesotho, Marshall Islands, Mauritania, Micronesia Fed. Sts., Moldova, Mongolia, Morocco, Nicaragua, Nigeria, Pakistan, Papua New Guinea, Paraguay, Philippines, Samoa, São Tomé and Principe, Senegal, Solomon Islands, Sri Lanka, Sudan, Swaziland, Syrian Arab Republic, Timor-Leste, Tonga, Turkmenistan, Tuvalu, Ukraine, Uzbekistan, Vanuatu, Vietnam, West Bank and Gaza, Yemen Rep., Zambia.

Country Category D

Afghanistan, Bangladesh, Benin, Burkina Faso, Burundi, Cambodia, Central African Republic, Chad, Comoros, Congo Dem. Rep., Eritrea, Ethiopia, Gambia The, Guinea, Guinea-Bissau, Haiti, Kenya, Korea Dem. Rep., Kyrgyz Republic, Liberia, Madagascar, Malawi, Mali, Mozambique, Myanmar, Nepal, Niger, Rwanda, Sierra Leone, Somalia, Tajikistan, Tanzania, Togo, Uganda, Zimbabwe.

ICTCT Secretariat, Secretary: Clemens Kaufmann, Danhausergasse 6/4, A-1040 Vienna, phone: +43 15041546,

fax: + 43 15041548, e-mail:

ICTCT Cashier: Hector Monterde i Bort, e-mail: