|Personal Details | | |Mr/Mrs/Ms | |First Name | |Other Given Names | |Family Name | | | | | | | | | |Date of Birth | |Aged 12–17yrs ? | |Gender | |Customer No. or Game Licence No. | | | |No / Yes |If ‘Yes’, no fee applies. |Male / Female | | | |Postal Address | | |Flat / Unit / House Number | |Street / Road Name or PO Box / RMB No. | | | | | |City / Suburb / Town | |Post Code | | | | | |Residential Address | |(If different from above). | |Flat / Unit / House Number | |Street / Road Name. | | | | | |City / Suburb / Town | |Post Code | | | | | |Which Game Species ? | |Which Licence Term ? | | |Tick One |Tick One |Short-Term or |Long Term | |( Deer (Stalking) | | | |( Deer (Stalking & Hounds*) |( $50.10 (or $25.00 concession) |( $150.30 (or $75.10 concession) | |( Game Birds, including Duck* |Valid to 31 December 2013 |Valid to 31 December 2015 | |( Game Birds, not including Duck | | | |( Deer (Stalking) & Game Birds, including Duck* | | | |( Deer (Stalking & Hounds*) & Game Birds, including Duck* |( $75.10 (or $37.50 concession) |( $225.30 (or $112.60 concession) | |( Deer (Stalking) & Game Birds, not including Duck |Valid to 31 December 2013 |Valid to 31 December 2015 | |( Deer (Stalking & Hounds*) & Game Birds, not including Duck | | | |To claim the concession rate, you must prove Show More
