Application Form 

Download and send as attachment to admin@elmtreelodge.com.au (filled in)

Download and Fax to(08) 8372 2555
(filled in)
Click Here for Download

 
Telephone: (08) 8372 2500
Facsimile:   (08) 8372 2555
 

4 Gladstone Street
Fullarton SA 5063

 
www.elmtreelodge.com.au
Elm Tree Lodge Online Application Form
   
Surname:
Given Name:
Date of Birth:
Sex: Male Female
Smoking: Yes No
Nationality:
Home Address:
Length of Stay (months):
Accommodation Date:
eg (01/01/2007 to 01/12/2007)
Institution Attending:
Courses Attending:
Car Park Required:
Phone:
Mobile:
Fax:
E-Mail:
Use of Cooking Facility
eg(daily, weekly, occassionaly)
Next of Kin:
Kin Address:
Kin Phone :
. .