Recreational Facility Permit

* Mandatory Field

Application Details
Applicant Details
Permit Number

To be completed by the Southern Mallee District Council

Application To*

[ the Authority ]

Contact Name*
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 and Days of the Event*
Event Hours*
Special Requirements

Please outline any Speciaql Requests that you may have for the Event

Event Description
Activity Description*

Please Describe the Activity

Agree with the Terms and Conditions
Recreation 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

Required Information Attached*

Please tick the box if you have included the required information as outlined in the Terms and Conditions

If you see this, leave this form field blank.

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

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