Qipd Registration Form

QIPd Registration Form

Effortless Quality Improvement
Includes a 30-day free trial!

You won't be charged until your trial period is over giving you the opportunity to see how Qipd works within your team! If you decide that Qipd is not for you, simply email admin@divergented.com.au to cancel your subscription.
Centre Information
Centre Name*
ABN*
If unsure, use ABN LookUp to help!
Initial User Name*

First NameLast Name
Initial User Email*
This will be the user who will be able to log-in and set up the centre account. Please use a different address to the Centre Email.
Centre E-mail*
example@example.com
Phone Number*

Area CodePhone Number

Subscription Type*

Monthly SubscriptionCancel Anytime!

Free for the first 30 Days then, $99AUD for each month

Quarterly SubscriptionCancel Anytime!

Free for the first 30 Days then, $297AUD for each three months

By submitting this form, you agree that your submission constitutes an electronic signature and serves as your confirmation of agreement to the terms and conditions provided. This electronic signature is legally binding under the Electronic Transactions Act 1999 (ETA) and is equivalent to a handwritten signature.
Should be Empty:

Includes a 30-day free trial!