Southern ACT Catchment Group

Applicant Particulars:

Name
Title	Mr Mrs Ms Dr
Group Name
Street Address
Address (cont.)
Suburb
State	A.C.T N.S.W
Post Code
Work Phone
Home Phone
FAX
E-mail

Site Description:

-Please Select- Lake River Creek Farm dam Reserve dam Stormwater channel

  

Other (please describe)

 

Site Location:

Please describe (Eg. Murrumbidgee River between Point hut and Pine Island)

Do you require training?

No

Yes

Do you require equipment?

No

Yes

How much time can you spare, how often?

15 minutes 30 minutes 1 hour 2 hours more than 2 hours     every    Week Fortnight Month Every 2 Months Rain Event

At this stage, you should print out this form and keep a copy for your records. Your information will now be passed onto the Waterwatch Facilitator, who in turn will organise to contact you directly.

Click on SUBMIT to send the form. If you are not contacted by the Coordinator within 48 hours, please ring on the numbers below to ensure the successful delivery of the form.