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 as soon as possible prior to commencing the program as spots are limited. A $100 deposit is required to secure your place. This amount forms part of the total program fee (not an additional charge). Bookings are only confirmed once the deposit is received.

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.