MIS Membership Application

Select Required MIS Membership: *

Membership to MakeItSafe is available upon the annual payment of the subscription fee of: (A) Ordinary Membership $75.00,Renewal $65.00, (B) Junior Membership, $50.00 Under 18's (C) Senior Membership, $50.00 Over 60's (D) *Corporate Membership, $800.00 Partnerships, Corporate Bodies, Trade Associations, for the period of one year upon approval.

Name *

First

Last

Date of Birth: *

Enter D.O.B in format: DD-MM-YYYY

ADDRESS: *

Email *

Email

Confirm Email

Phone Number: *

Please enter contact numbers separated by comma(,).

Whatsapp Number:

GENDER: *

FEMALE
MALE

DRIVERS LICENCE / PERMIT TYPE *

I am a (Tick the applicable option) *

New Member
Former Member

what type of road user are you? *

Driver
Motorcyclist
Cyclist
Walker
All of the Above

My Special Area of Interest: (Please tick where applicable:) *

OCCUPATION *

Comment or Message *

Reason for joining MIS *

What would you like to gain from MIS? *

Do you require a ****@makeitsafe-bb.com email address

Yes
No
Not Sure

HOW DID YOU HEAR ABOUT US? *

MIS Membership Agreement *

First

Last

I ___________________________ agree to abide by the code of conduct listed in the MIS Constitution for members of the Association. I understand I must drive my motor vehicle or as walk as a pedestrian, placing safety first, at all times, and in compliance with the rules and regulations of the Barbados Road Traffic Act. I also promise to set a positive example in my behaviour on the roads of Barbados at all times.

DATE: *

By ticking this box you agree to be bound by MIS agree to abide by the code of conduct listed in the MIS Constitution for members of the Association *

I Agree

MIS Membership Application

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