Actively HUMAN Purchase Form

1
Actively HUMAN Pricing

The Standard Rate is $199 per person.

Discounted rates apply automatically for teams:
• 10 seats → $179 per person
• 20 seats → $159 per person
• 30 seats → $139 per person

For groups larger than 30, please email human@thequietrebel.org.

We also offer an Accessible Rate of $89 (limit 2 per customer, no questions asked).
2
Date
Date
Month
Day
Year
3
Name
First Name
Last Name
4
Email
example@example.com
5
Number of Seats - Standard Rate* This field is required.$199 per person with price breaks per 10 seats up to 30 seats
6
Number of Seats - Accessible Rate$89 per person - maximum 2 per order
7
Per person rate
8
We are very excited to get your team onboarded using Actively HUMAN. We want to keep prices accessible and fair, so we would love to discuss your specific needs. Please reach out by email to human@thequietrebel.org.
9
Verify total before checkoutTotal = #of standard seats x rate per seat based on sliding scale + #of accessible seats x $89
10
Order Summary
11
Terms and Conditions* This field is required.
12
Order Number
13
Support Code
14
Checkout in Stripe* This field is required.Please verify total before hitting submit
prevnext( X )
Description
USD
+ OR enter a custom value
Should be Empty: