Guest Registration Form

Guest Registration Form

RV Short Stay - Railway Street, PITTSWORTH QLD 4356
Vehicle Registration Number *
of the towing vehicle
Vehicle Registration Number *
of the caravan/trailer
Full Name *

First Name Last Name
Date of Birth *

Day Month Year
Mobile Number *
Nationality *
Please fill in the following vehicle detail
Vehicle Registration* Caravan/Trailer Registration
Date of Expiry *

Day Month Year
Place of Issue *
Country of Birth *
Date of Arrival *

Day Month Year
Intended Length of Stay *
days - this site is limited to 3 days
Nightly fee of $10 per site

Terms & Conditions
*

1. Bookings and enquiries only with Pittsworth District Alliance on 0481 353 055 or email info@pittsworth.org 2. Stays are limited to 72 hours/3 days 3. Pets are welcome but must remain under the owners control at all times 4. No fires 5. No outside guests 6. No access to water, electricity or toilets 7. I hereby agree to the terms & conditions stated above and that all information provided by me is true.
Name

First Name Last Name
E-mail Address
Date

Day Month Year
Pittsworth District Alliance

PO Box 503 PITTSWORTH 4356

0481 353 055

info@pittsworth.org

www.pittsworth.org
Your booking will be confirmed by phone
Should be Empty:

Terms & Conditions