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Student Membership Application
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Student Membership Application
Full name *
Date of birth *
Mobile number *
Email (non-university) *
Postal Address *
Suburb *
State *
NSW
QLD
SA
VIC
WA
TAS
ACT
Other
Postcode *
Student ID (if any)
Primary Chiropractic Degree
Degree name *
Bachelor of Chiropractic Science / Master of Chiropractic
Bachelor of Science (Chiropractic)
Bachelor of Clinical Chiropractic
Bachelor of Health Science / Bachelor of Applied Science (Chiropractic)
Bachelor of Health Science (Chiropractic)
Bachelor of Chiropractic
Other
University *
CQUniversity
Macquarie University
RMIT University
Murdoch University
Adelaide Chiropractic College University
Other
Campus *
Select campus
Start Year *
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
2047
2048
2049
2050
Expected Graduation *
January
February
March
April
May
June
July
August
September
October
November
December
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
2047
2048
2049
2050
Additional tertiary study?
No
Yes
Degree / Course name
University
Admission Year
Completion Year
SOT Involvement
Attended SOT Seminar/Workshop?
No
Yes
Year(s) attended
Declaration
I declare that the information provided is true and correct.
Typed Signature (Full Name) *
Signature Date
Submit Application