MEN'S BEHAVIOUR CHANGE PROGRAM REGISTRATION FORM

I would like to do the 20-week Men’s Behaviour Change Program. I understand that the program will run via ZOOM. I also understand that confirming my enrolment can only take place once I have made payment of the course fee. To open a registration form, choose either “Click here to REGISTER and pay via PayPal” or if you do not have a PayPal account “Click here to REGISTER and pay Later”.

Program commences Monday 25 November. 6pm to 8pm. $950
HOWEVER THIS PROGRAM IS FULL.

New program starts end of February 2025.
Register by the middle of December for this program

Deadline to pay for this course Mid February 2025
Consider paying 50% ($475) to hold your place.

Direct Deposit Details

BANK: Commonwealth
ACCOUNT NAME: SANCTUM
BSB: 06-3215
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: