ASIRT Education Abroad Membership
Secure Payment Form
 
Order Summary and Discounts:
Order Date: 12/10/18
Annual payment:
20% ASIRT 1st year member discount for URMIA or FORUMEA members and Terra Dotta users. Enter discount amount $:
$50 discount for all renewing members. Enter discount amount $:
$100 additional discount if renewing for 2 years (2017-2018; 2018-2019). Enter discount amount $:
TOTAL - please manually enter payment amount, including discounts, if applicable. $:
Example: Renewing member for 2 years at the $1,000 membership level would pay $1,000x2 years - $50 renewal discount = $1,950 - $100 2-year discount = $1,850.

Request Reports
(ex: unlimited; or
1.Tunisia, 2.Gabon, etc.):
Specify quantity for each Speak Up for Safety Card (French, Spanish, Chinese, Russian) included in membership levels for 5 or more reports:
ASIRT PowerPoint, Road Safety Checklists, Role-play scenarios and Press release are automatically included.

Debit or Credit Card Information:
Card Type:

Name as on Card:
Card Billing Address:
Card Billing Zipcode:
Card Number:
Card Expiration Date: MMYY
Card ID (CVV2/CID) Number:
 
[What is the Card ID?]
   
Contact Information:
School Name:
Contact First Name:
Contact Last Name:
Address:
Address Line 2:
City:
State:
Zip:
Phone Number:
Email Address:
Terms of Agreement:

When you select "Process Payment," you agree that you represent a school and its education abroad and/or risk management offices or nonprofit organization, and are not a representative of a Business or Corporation or business traveler. Click here for information about these memberships.

NOTE: You agree that you, the organization you represent, and its constituents immediately will discontinue to use any portion of ASIRT's reports and/or other resources if your membership expires and you elect not to renew. Your membership fee provides you with the license to use ASIRT materials only for the duration of your membership year(s).