Register for Drink Driving Programs & Events

"*" indicates required fields

Please Note: Payment only necessary for Part One (Cost covers both parts of the program)

Your Surname*

Given Names*

Email*

Contact Phone*

Date of Birth*

Drivers Licence Number

Your Address

Street Address City State / Province / Region ZIP / Postal Code

Date of the Offence

What was your BAC reading?*

Please provide a description of any other charges made:*

Number of related offences in the last 10 years*

Date of prior offence (if applicable)?:

Is there anything else we should know about?

Payment Options

$360 + $67 Vic Roads Fee

$360 + $34 Vic Roads Fee (with concession/centrelink card)

For credit card payments please contact us
on 9654 3321.

Please note, the $67 and $34 fees are VicRoads fees and not ours and are required to be paid prior to commencement of the program.

Centrelink/Concession Card Number

(e.g. Centrelink card No.)

Centrelink/Concession Card Expiry

Non-refundable $100 deposit required.

Please contact us to organise a $100 deposit. Deposit must be paid minimum 5 days prior to commencing the program. If deposit is not paid, you are not booked in.

For advance payments, your payment must be made minimum 2 days prior to the program date.

Registration

Please Note: Payment only necessary for Part One (Cost covers both parts of the program)

For credit card payments please contact uson 9654 3321.

Non-refundable $100 deposit required.

Approved by VicRoads

For credit card payments please contact us
on 9654 3321.