Let's book you into

Advance Care Planning (ACP) Workshops (Term 3 2024)

by Vermont South Neighbourhood House

Step 1, You

First we need basic details about you so we know who you are and can get in touch with you.

First Name (required)

Last Name (required)

Email (required)

REQUIRED Either a mobile no or phone no must be provided.

Mobile No

eg. 0499 999 999

Phone No

eg. 03 9999 9999

Step 2, Billing Address

REQUIRED

Unit or Apartment No. (only if required)

Street No. and Address

Or specify address without using Google Maps

I have previously participated in activities run by Vermont South Neighbourhood House

Step 3, Choices

Package Selection	Price
Standard
5 sessions	$60.00

Step 4, Payment

Payment Method

Pay by credit card

Pay by other means

Name on Credit Card

Credit Card Number

Expiry Date

CVC / Security Code

ATTENTION This charge will appear as SOCIAL PLANET Mornington on your credit card statement. Social Planet is providing secure payment processing on behalf of Vermont South Neighbourhood House.

Step 5, Additional information

How did you hear about us? (required)

Would you like to occasionally receive news and information via email from us?

Additional Info

Step 6, Privacy Information and Declaration

Photo Consent

Photographs or recordings may be taken during your time with us for use in publicity material.

Types of publicity may include social media, display boards, power point presentations, newsletters, news articles, or reports.

Do you consent to our usage of photographs or recordings where you may appear as part of your involvement with us? Do you also consent for your first name to be used with these photographs or recordings?

Yes, I give consent for my image to be used

Privacy Consent

Vermont South Neighbourhood House cares deeply about your privacy, and always endeavours to collect and store your information in such a way that it fully complies with our own privacy policy and that of information privacy laws.

A full version of our privacy policy is available on our website, www.vsnh.org.au, and should you have any questions please feel free to get in contact with us either in person, through email/our website, or via. telephone.

Yes, I give consent to have information about me collected, and shared only when applicable

About the provider

Vermont South Neighbourhood House

Vermont South Neighbourhood House offers programs and services in a friendly environment to meet the needs of the local community.

These include adult education, lifestyle & recreational courses, children’s activities, a social enterprise café & catering, and room hire. Please check out our full range of programs and events below, and if you have any questions don't hesitate to get in touch via phone, email, or our website!