Behaviour Change Program – Online Location: Online « Behaviour Change Program Details Date: Please see all of our upcoming online course dates below. ⮞ 24/10/2020 and 31/10/2020 (BOOKED OUT) ⮞ 14/11/2020 and 21/11/2020 (Next Available) ⮞ 05/12/2020 and 12/12/2020 Please Note: A spot will be reserved for you in the next available course Sessions run from 9:00 am to 12:00 pm Online programs are run via Skype, so please ensure you have an account to participate in the 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.Name:* First Last 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 Age:*Licence Number (If you have one)Sex:*MaleFemaleNo. of Offences Last 10 Years:*Blood Alcohol for This Offence:*Date of This Offence:* Date Format: DD slash MM slash YYYY Date of Disqualification From:* Date Format: DD slash MM slash YYYY Date of Disqualification To:* Date Format: DD slash MM slash YYYY Previously Completed a Drink Drive Course?*YesNoDate Completed:* Date Format: DD slash MM slash YYYY 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 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Expiration Date Security Code Cardholder Name CAPTCHAEmailThis field is for validation purposes and should be left unchanged.
