Registration Form

Interconnected Leader

11-week virtual program from 23April 2026 – 2July 2026

First Name

Last Name

Email

Mobile Number

PO Box or Street Address

City

Post Code

State

Country

Your Age Range

Gender

Are you of Aboriginal / Torres Strait Island or First Peoples Origin?

YesNo

Do you have a referral code?

Please enter your referral code

How did you hear about this course?

Referrer Name

Other Referrer

How would you prefer to pay for this program? (All referral invoices paid by invoice)

By Credit CardBy Invoice

Who should we invoice?

MeMy Organisation

Organisation Name

ABN

Billing Street

Billing City

Billing State

Other Billing State

Billing Post Code

Billing Country

Accounts Payable First Name

Accounts Payable Last Name

Accounts Payable Title or Position

Accounts Payable Email

Accounts Payable Phone

Total Amount to be paid to Small Giants Academy Limited including GST

Price is shown in AUD

Please use web browser other than Internet Explorer if you are paying by Credit Card.

Name on Card

Card Number

Code

Billing Email

I understand that by submitting this form I am agreeing to pay for this program by the invoice due date, in accordance with Small Giants Academy Terms and Conditions.

Program ID

This is the Program ID for this form - Interconnected Leader - March - May 2025 (Form ID: 5152291)

Campaign ID

This is the Campaign ID for this form - Interconnected Leader - Sep - Nov 2025 (Form ID: 5152291)

Owner ID

This is the Owner ID of Joel

Application Type

Developer Notes

Update Campaign ID on Zapier
Update Campaign ID on the Hidden Field on this form
Calculations are defined on this form
No GST to be charged if the event is happening outside Australia
Check what currency is in the Stripe Connector

Calculations:

Fee Amount is Discount applied for different sectors. Only two discounts are required - 20% for Charity/NFP and 20% for First Nations.

FinalAmount is Sector Amount less Discount Amount from Referral Code.Referral Code should be hidden for

Charity/NFP and First Nations as discounts are not cumulative.
Check Program and Owner

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