Date of Birth______________________________
Sex___________________
Nationality______________________________
Home Address____________________________________________________
Length of Stay at Elm Tree Lodge: From_____________
To_______________
Institution
Attending________________________________________________
Courses
Attending_________________________________________________
Postgraduate/ Undergraduate/
Exchange_______________________________
Phone_____________________
Mobile_____________________
Fax_______________________
E-Mail__________________________________________________________
Car Park Required____________
Smoking_______________
Use of Cooking Facility: Daily/ Weekly/
Occasionally______________________
Next of
Kin_______________________________________________________
Address_________________________________________________________
Contact.
Phone___________________________________________________
(Complete this form and email to admin@elmtreelodge.com.au or fax to 08
83722555)
Please
note incomplete form will not be processed.