Low or Middle Income Country – Full Membership

Member Details

First name *

Last name *

Organisation (optional)

Position/Role (optional)

Organisation Type (optional)

Sector (optional)

Country *

Street address *

Apartment, suite, unit etc. (optional) (optional)

Suburb *

State *

Postcode *

Phone *

Email address *

Create account password *

Mailing List Signups - Special Interest Groups

Scaling up Physical Activity (optional)

Physical Literacy (optional)

School Physical Activity (optional)

Physical Activity in Healthcare (optional)

Additional Biller Details

Name (optional)

Email (optional)

If provided, a copy of the order details will be send to this email address.

Address (optional)

Phone (optional)

Additional information

Student Institution or Organisation (optional)

Student ID (optional)

Student Full time/Part Time (optional)

Student Date of Enrolment

Student Expected Duration (years) (optional)

Upload Student ID (Required for Student Membership)

Drag file here or click to upload

Please submit proof of your student status by uploading a picture or scan of your student ID with expiry date here. Accepted file types are .jpg, .jpeg, .gif, .png. Your file will be uploaded to our hosting server where it will be verified by a member of the ASPA team before being deleted off the server.

Your order

Product Quantity	Total
Cart Subtotal	$0.00
Order Total	$0.00

Credit Card (Stripe)
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Card Number *

Expiry Date *

Card Code (CVC) *

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