Council Dirt Bike Track Facilities Permit

* Mandatory Field

Application Details
Applicant Details
Permit Number

To be completed by the Southern Mallee District Council

Application To*

[ the Authority ]

Contact Name*

[ the Permit Holder if application is made by an Individual ]

Organisation/Business Group Name*

[ the Permit Holder ]

Address*
Email Address*
Telephone*
-

Please include your Home and Mobile Telephone Numbers

Event Name and Dates
Event Name*
Location of the Event*
Date of the Event*
Event Hours*
Special Requirements
Event Description
Activity Description*

Please Describe the Activity

Agree with the Terms and Conditions
Dirt Bike Track Facility Permit Terms and Conditions*

By ticking this box you are deemed to have read and agree with the Stallholder Terms and Conditions

Click Here to View the Terms and Conditions

Please attached current copy of your Insurance and any required Licences

Have you attached your required Documents*

Please attache the required documents to your application

If you see this, leave this form field blank.

Send a copy of the submitted form to this email address.

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