• Who is submitting this form?

Your Name:
Your School:
School Address:
	State: ACT NSW NT QLD SA TAS VIC WA Postcode:
Contact E-Mail:
School Phone:	(Please include area code)
School Fax:	(Please include area code)

• What is the full name of the Teacher who will be in charge at Mt. Buller/Stirling?

• If a mobile phone will be carried during your visit, what is the phone number?

• What is your proposed visiting date to the Mt. Buller/Stirling Alpine Resort?

Arrival Date:
Departure Date:

• How many students will be visiting the Mt. Buller/Stirling Alpine Resort?

• How many Teachers/Assistants will be visiting the Mt. Buller/Stirling Alpine Resort?

• As the teacher in charge does the following statement apply? Please Select YES this is an official school function NO this is not an official school function

Statement

By submitting this form the School concurs that this proposed trip to Mt. Buller is an official school function and a component of the student's curriculum.   The School hereby applies for mid-week school student Resort Entry concession rates.

(Please Note: School Rates and free teacher admission apply to mid-week visits only.  The Student concession and/or adult rate will apply for all members of the group on week-ends)

(Please Note:  If you are not comfortable with submitting this information via the Internet or; do not have the facility to do so, then please fill out the above details, print out the page and fax the hard copy to 03 5777 6219.)