Land For Wildlife Application Form

Land for Wildlife Application Form

To apply for Land for Wildlife, please print and complete this application form and forward it to:
Felicity Nicholls, Land for Wildlife Coordinator
Department of Sustainability & Environment, North West Region
Box 3100, Bendigo Delivery Centre
BENDIGO VIC 3554

Phone: (03) 5430 4363
Fax: (03) 5448 4982
felicity.nicholls@dse.vic.gov.au
DOC Icon Land for Wildlife Application Form (DOC - 39 Kb)
Logo: Land For Wildlife

Name:

Postal Address:

Daytime Telephone & Mobile (if applicable):

Email:

Organisation (if applicable):

Date of application:

I/we wish to apply for Land for Wildlife registration for the property at:

Property name:

Property Location:

Size of whole property:

First application?

Yes / No ?

(Optional) How much and what type of remnant vegetation do you have? Do you have any threatened species?

It would assist us if you briefly note in the space opposite how you heard about Land for Wildlife? (e.g. riend, neighbour, saw the sign, BOCA ...)

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Name:
Postal Address:
Daytime Telephone & Mobile (if applicable):
Email:
Organisation (if applicable):
Date of application:
I/we wish to apply for *Land for Wildlife* registration for the property at:
Property name:
Property Location:
Size of whole property:
First application?	Yes / No ?
(Optional) How much and what type of remnant vegetation do you have? Do you have any threatened species?
It would assist us if you briefly note in the space opposite how you heard about **Land for Wildlife? (e.g. riend, neighbour, saw the sign, BOCA ...)**

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