MEN'S BEHAVIOUR CHANGE PROGRAM REGISTRATION FORM

Program starts:  Monday 20 April 2026. 6pm Melbourne time.

If DFFH ( Child Protection) are involved with you or your family, please refer yourself to a government funded agency who are more able to assist with their requirements.

I want to join the 20-week Men’s Behaviour Change Program run via ZOOM. My enrolment is confirmed only after payment. To register, choose: ‘Click here to REGISTER and pay via PayPal’ or, if you don’t have PayPal, ‘Click here to REGISTER and pay later.’ Use the ‘pay later’ option then use the BSB and Account number to pay 50% ($475) (RECOMMENDED) immediately to secure your spot if you are serious.

Balance of $475 to be paid before the deadline date –  Friday 10 April 2026

Program commences Monday 20 April 2026. 6pm to 8pm. Melbourne Time. $950

Deadline to register and pay is Friday 10 April 2026.
Do not wait for this date, as the program will fill before then.
Consider paying 50% ($475) to hold your place if you are serious.

A refund can be provided if you pull out before Friday 10 April 2026.
However, there is no refund after this date as we need to lock things in and make preparations. 

Use the “..REGISTER and pay later” option. Write down the bank details below.

Direct Deposit Details

BANK: Commonwealth
ACCOUNT NAME: SANCTUM
BSB: 063215
A/C No: 00326191

    Your Details:






    Who Referred You?:



    Please select the appropriate responses:

    Do you have a Court Order to do this group?

    Do you have an Intervention Order?

    Are you currently living with your partner and children?

    When are you next appearing in Court?

    Registration Process and Conditions:
    By typing my name in the space below and submitting this form, I am confirming that I have read, understood and agree to the MBCP MANDATORY Participation Agreement..

    I, have read and agree to comply with the above-mentioned agreement.

    I understand that I will be emailed a copy for signing.

    Comments:

      Your Details:







      Who Referred You?:




      Please select the appropriate responses:

      Do you have a Court Order to do this group?

      Do you have an Intervention Order?

      Are you currently living with your partner and children?

      When are you next appearing in Court?

      Registration Process and Conditions:

      By typing my name in the space below and submitting this form, I am confirming that I have read, understood and agree to the MBCP MANDATORY Participation Agreement..

      I, have read and agree to comply with the above-mentioned agreement.

      I understand that I will be emailed a copy for signing.

      Comments: