LAND FOR WILDLIFE
LANDHOLDER EXPRESSION OF INTEREST FORM
Please indicate or include name of contact person/s
Property Name &
or extra phone N
Yes, I am interested in receiving free on site advice on managing part of my land as
habitat for native plants and
I understand that my Assessment will be done as
es, I would like to be included on the mail list for
newsletters and other information
OTHER PROPERTY DETAILS
These details help us pr
epare for your site visit
Lot and DP
Lot or Portion N
Parish and County
The Lot and DP enable us to prepare a base map and vegetation community map to bring to the site visit.
Area of property
a of property with native vegetation
(1 acre = 0.405ha, 1ha = 10 000m
(including areas of trees, native grassland etc.)
Local council area
eg Fires Ck, Bunning Ck
NRM Region (CMA)
The information y
ou provide will be used in accordance with the Privacy & Protection of Personal Information Act 1998. All information that is
collected can & will only be used for project administration. It cannot be given to any other party without your permission.
u are concerned about
how this information may be used we will be happy to discuss it with you.
Please complete the other side...
urn form to: PO Box 149 Ourimbah 2258
Fax: 4349 4755 Email:email@example.com Phone: 4349 475
C. YOUR INTERESTS
These details help us prepare for your site visit
The Land for Wildlife program aims to help landhold
ers look after natural vegetation on their lands. Participation in this project
is entirely voluntary. We can assist you by visiting your property, giving you advice on the natural values of your property
how you can manage the natural areas on your la
nd. We can also provide you with advice on incentive programs designed to
help landholders and protect vegetation. Other opportunities include workshops, training, networking with other landholders,
help with plants, bush regeneration (depending on availab
ility) and advice / help regarding funding opportunities.
Are you aware of conservation incentive programs for private landholders?
YES / NO
Are you interested in conservation incentive programs?
YES / NO
Are you curre
ntly involved in a conservation incentive program?
YES / NO
If yes, which one/s?
2. Reason for
I would like advice on:
Weed control / weed management
Native plant identification
ng habitat for wildlife
Habitat assessment of my property
Seed collection and propagation
Supply of locally native plants
Property management advice
What are the main values of your land to you?
Why do you think your land is valuable as w
ildlife habitat? _____________________________
5. Property Sketch
Draw a sketch of
•buildings / house
•areas you to
If there is any additional information you would
like to provide on your land or why you are interested in the program you may
attach a separate sheet.
Return form to: PO Box 149 Ourimbah 2258 Fax: 4349 4755 Email:firstname.lastname@example.org Ph: 4349 475