Application for Port Lincoln Town Jetty Salvaged Timber - Community Project

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* 1. Organization Name

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* 2. Is your organization a not for profit incorporated association?

Yes

No

Other (please specify)

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* 3. Please provide your ABN ( if applicable)

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* 4. What are your organization's vision and values? Please provide local membership details.

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* 5. Please describe your community initiated project including details of any permissions or approvals you have obtained.

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* 6. Describe the community benefit of the project.

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* 7. How will you ensure public access to the project?

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* 8. Please attach a copy of the plan, sketch, design of your project

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

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* 9. How much timber do you need?

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* 10. What grade of timber do you need?

Grade 1 - Excellent Condition

Grade 2 - Good Condition

Grade 3 - Fair Condition

Grade 4 - Poor Condition

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* 11. Are you willing to sign an Indemnity and Waiver Form?

Yes

No

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* 12. Please provide contact details

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number