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
Capricornia School Distance Education P&C
Dingo State School P&C & Capricorn Helicopter Rescue Service
ICPA Capricornia Branch
Marlborough State School P&C & Capricorn Helicopter Rescue Service
Rockhampton Junior Beef
Second Beneficiary
Choose One
Capricornia School Distance Education P&C
Dingo State School P&C & Capricorn Helicopter Rescue Service
ICPA Capricornia Branch
Marlborough State School P&C & Capricorn Helicopter Rescue Service
Rockhampton Junior Beef
Entries
Notes
Total Cost
