Application Details

Business/Trading Name

ABN

Contact Name

Contact Number

Contact Email

Address

Suburb

State

Postcode

PIC No.

MSA No.

Are you EU accredited?

Have these animals been treated with HGP’s?

If the answer is Yes but you have entries that are not HGP treated please submit a second form.

Beneficiary

Choose One CSDE P&C ICPA Capricornia BOTA Marlborough State School P&C Ridgelands & District Sporting & Agricultural Assoc. Inc. Rockhampton Junior Beef Stanwell State School P&C

Entries

Notes

Total Cost

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