First Name (required)

Family Name (required)

Email (required)

Organisation/University

Phone Number

Address

Suburb or City

Postcode

I would like the following number of tickets:

event subscriber tickets* (no charge)

tickets at $35 (incl GST)

student tickets at $15 (incl GST). Student ID# required

I would like to sponsor a student/s to attend this event:

sponsored student tickets at $15 (incl GST)

I have the following dietary requirements

Paying over the phone Paying via direct deposit 

If paying via direct deposit please submit your payment to your banking institution first, putting your full name in the reference section of your bank's online form and including your receipt number here:

If paying over the phone, via Mastercard or Visa only, please leave a business hours phone number and we will contact you:

Direct Deposit Information

BSB 124-010
Account number 10533623
Account name The Brisbane Institute
Important: Please include your full name in the reference area so we can identify your payment. Please email a copy of your direct deposit receipt to peter@brisinst.org.au to start accessing your Institute benefits right away.

Phone Payment Information

We will contact you soon to gather your payment credentials.

Event series subscriptions
*If you have taken out an event subscription, please register your name and any dietary requirements. If you would like to know more about event subscriptions, visit http://www.brisinst.org.au/events/brave-ideas-series-subscription.

All information is kept private