Student Activators | Australian Spinal Research Foundation

Name*
Prefix First Last
I am purchasing as a:
- Individual
- Company
Please indicate for receipting purposes.
Practice Name, if purchasing as a company
Student's Personal Email*
Student's Mobile Number*
Address for receipting purposes*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Delivery address (if different from above address)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Campus*
- Australian Chiropractic College
- Macquarie University
- Murdoch University
- RMIT University
- CQ University
- NZCC
- Other
If 'Other' campus, please include below:
Year of Graduation*
Student ID Number*
I would like to pay in the following way:*
- One payment, with delivery as soon as possible (as advised by ASRF). NO ACCOUNT FEE will be charged.
- 4 MONTHLY payments, with delivery AFTER final payment. First payment will be processed within 1 week of order. Non-refundable ACCOUNT FEE APPLIES.
- 4 QUARTERLY payments, with delivery AFTER final payment. First payment will be processed within 1 week of order. Non-refundable ACCOUNT FEE APPLIES.
Choose your Activator (Prices are in Australian Dollars)*
Payment Type*
- Visa
- Mastercard
- American Express
Credit Card Number*

Please double check your entry.
Card Expiry*
CCV*
Cardholders Name*
I understand and agree with the following:*
- I authorise the ASRF to process payments as per the option I have chosen above. If I have chosen a payment plan, I understand that delivery of my Activator will be AFTER the final payment. I understand that if I fail to pay the agreed amount in full or cancel my order, the ASRF will retain my $75 account fee. The account fee will be added to the first payment. If you have chosen a payment plan, the ASRF will send you a confirmation email with payment schedule outlined.
Total (AUD)
Payments will be scheduled as per your choice in the field above. Total is the full cost of the Activator Tool.
$ 0.00

ASRF Student Activator Offer

Fill in the form below to order your Activator. This offer is available to current Chiropractic Students ONLY.