Name of organisation:

Address of organisation:

Name of person who will lead the group at Lizard Island:

Group leader's position within organisation:

Group leader's contact details:

Phone:

Fax:

Email:

Name of person organising trip (if other than group leader):

Organiser's position within organisation:

Organiser's contact details:

Phone:

Fax:

Email:

Number of people in group:

Students

Staff/ supervisors

Others

Outline role of others

TOTAL

Year level(s) of students in group:

List any course or other prerequisites for students taking part in this trip:

Preferred arrival date:

Earliest possible arrival date:

Preferred departure date:

Latest possible departure date:

Boating & diving

Outline the group leader's level of boating experience:

Outline the level of boating experience among the other supervisors:

Outline the group leader's level of snorkelling experience:

Outline the level of snorkelling experience among the other supervisors:

Do you plan to offer scuba diving to suitably qualified members of the group?

Yes No

If so, outline level of diving qualifications and experience of the group leader or other supervisors.

Educational program

Do you need to collect, damage or move marine or terrestrial organisms to conduct the work planned during this trip?

Yes No Maybe

Do you plan to use site markers (e.g. buoys, flagging tape) or any other equipment in the marine or terrestrial environment that will be left in place overnight or longer?

Yes No Maybe

Other than ethanol and formalin, will you be using any laboratory chemicals?

Yes No Maybe

Do you already hold any permits to conduct the planned educational program?

Yes No

Permit numbers:

Have you applied or do you intend to apply for any of the following permits for the planned educational program?

Marine Parks permit

Yes No

Date of application

Fisheries permit

Yes No

Date of application

Any other permit

Yes No

Date of application

List aquarium facilities required:

List laboratory/teaching equipment required:

You can expect to hear from the Research Station by e-mail within two working days of sending this application.

E-mail this form to the Lizard Island Research Station now