Behaviour Change Program – Online Location: Online « Behaviour Change Program Details Date: PLEASE ENSURE THAT YOU HAVE YOUR VICROADS REQUIREMENT LETTER BEFORE YOU MAKE A BOOKING INTO YOUR CORRESPONDING BEHAVIOUR CHANGE PROGRAM The form below will display all available dates for 2021. A spot will be reserved for you in the next available course Online programs are run via Skype, so please ensure you have an account to participate in the program You will receive an email a week before your course begins with handouts and further details regarding your program A working camera and microphone are mandatory for participation purposes Price: $439.00 (plus Vicroad Cost)* Venue Online Note: for the concession Vicroads cost you will need to present your concession card on arrival to BCP Participants are only eligible for this program (BCP) for Licence Restoration in Court and/or VicRoads. Step 1 of 2 50% PLEASE BRING PHOTO ID ON THE SECOND SESSION OF THE PROGRAM IN ORDER FOR US TO ISSUE YOU WITH YOUR CERTIFICATE OF COMPLETION.Desired Program*Please note that if you are looking for an Intensive Drink or Drug Driver course, we are unable to provide this service.Drink Driving BCPDrug Driving BCPHas VicRoads instructed you to participate in a drink or drug Behaviour Change Program via phone or letter?*DO NOT CONTINUE If your answer is NO or you are not sure. Please dial 1300 723 790 for assistance from VicRoads. YesNoIs this your FIRST drink or drug driving offence in the past 10 years?*If your answer is NO, you require an INTENSIVE Behaviour Change Program. Please dial 1300 723 790 for assistance from VicRoads. YesNoWas your blood alcohol content under 0.15?*If your answer is NO, you require an INTENSIVE Behaviour Change Program. Please dial 1300 723 790 for assistance from VicRoads. YesNoBCP Drink Driving Dates*Please click a suitable date. All courses are on Saturdays.1st & 8th May, 9am - 12pm15th & 22nd May, 9am - 12pm5th & 12th June, 9am - 12pm19th & 26th June, 9am - 12pmBCP Drug Driving Dates*Please click a suitable date.1st & 8th May, 3pm - 6pm2nd & 9th May, 3pm - 6pm15th & 22nd May, 3pm - 6pm5th & 12th June, 3pm - 6pm19th & 26th June, 3pm - 6pmName:* First Last Email:* Enter Email Confirm Email Phone:*Billing Address:* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Date of Birth:* Date Format: DD slash MM slash YYYY Licence Number (If you have one)No. of Offences Last 10 Years*Please enter a number from 1 to 1.If you have 2 or more offences in the last 10 years and/or you have a BAC reading that is 0.15 or above, you are not eligible for the standard BCP and require an intensive program. Blood Alcohol for This Offence*Please enter a number less than or equal to 0.149.If you had a reading that was 0.15 or above, you are required to attend the intensive program. Please contact VicRoads for further information.Drug Offence Details*Which elicit substance/s was taken at the time of offence? Behaviour Change Program – Online* Price: $ 439.00 GST* Price: $ 0.00 VicRoads Administration Fee*-- SELECT VICROADS FEE --Non-ConcessionConcessionConcession Card Number:*Credit Card Surcharge* Price: $ 10.00 Total: $ 0.00 Payment:* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name CAPTCHASection BreakNameThis field is for validation purposes and should be left unchanged.