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* 2. Your personal details

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* 4. Please tell us a little bit about your interest in clinical trials and registries, including any areas of special interest or expertise.

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* 5. Please list any Clinical Trials Networks, Clinical Trial Coordinating Centres or Clinical Registries that you are affiliated with.

A copy of ACTA's company constitution is available from our website at ACTA Constitution.

As a public company limited by guarantee bound by the Corporations ACTA (2001), all members of ACTA are required to contribute $10.00 to the assets of the Company if it is wound up while they are a member or within one year after they cease being a member. 

All applications for ACTA membership require approval by the ACTA Board of Directors. A member of the ACTA team will be in touch shortly to acknowledge receipt of your application.
An application for membership must be signed by the applicant to be in accordance with our Constitution. For security purposes we request your signature in the below format. 

Signature Format:  Firstname_Surname_DDMMYYYY

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* 6. Applicant Signature

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* 7. By submitting this application form you acknowledge that you wish to apply to become an Affiliate Member of the Australian Clinical Trials Alliance Ltd (ACTA) and accept and have read and understood the terms and conditions of ACTA membership as outlined in the constitution.

Please note an invoice will be sent according to the details provided in this form following membership approval by ACTA's Board of Directors.