LRG Member Lease Visitation Form

LRG Member Lease Visitation Form

Use this form to let LRG know that you are visiting our leases. This form allows for up to 4 members visiting up to 6 leases. Please enter the members names and member numbers, then select which lease/s you will be visiting, along with your arrival and departure dates for each lease, then hit the Submit button at the bottom of the form.
Members please note:

Prior to travelling to any of LRG’s leases, it is the responsibility of all LRG members to notify the Pastoral Lease Holder (PLH) that LRG leases are on, of your intention to visit a lease.

Pastoral Lease Holder details can be obtained from the Department of Mines, Petroleum and Exploration (DMPE) by phoning (08) 9222 3333.

PLH details may include an email address, landline or mobilephone number. Sending an email, leaving a message on an answering machine or sending a text message to a mobile number is sufficient to ensure your obligation for notifying the PLH.
1st Member's Name*

First NameLast Name
Member's No. member number*
2nd Member's Name

First NameLast Name
Member's No. member number
3rd Member's Name

First NameLast Name
Member's No. member number
4th Member's Name

First NameLast Name
Member's No. member number
Select 1st LRG Least That You're Visiting*
Date of arrival at 1st LRG lease*

DayMonthYear
Date
Date of departure from first LRG lease*

DayMonthYear
Date
Select 2nd LRG Lease That You're Visiting, if applicable, or hit the Submit button, below
Date of arrival at 2nd LRG lease

DayMonthYear
Date
Date of departure from 2nd LRG lease

DayMonthYear
Date
Select 3rd LRG Lease That You're Visiting, if applicable, or hit the Submit button, below
Date of arrival at 3rd LRG lease

DayMonthYear
Date
Date of departure from 3rd LRG lease

DayMonthYear
Date
Select 4th LRG Lease That You're Visiting, if applicable, or hit the Submit button, below
Date of arrival at 4th LRG lease

DayMonthYear
Date
Date of departure from 4th LRG lease

DayMonthYear
Date
Select 5th LRG Lease That You're Visiting, if applicable, or hit the Submit button, below
Date of arrival at 5th LRG lease

DayMonthYear
Date
Date of departure from 5th LRG lease

DayMonthYear
Date
Select 6th LRG Lease That You're Visiting, if applicable, or hit the Submit button, below
Date of arrival at 6th LRG lease

DayMonthYear
Date
Date of departure from 6th LRG lease

DayMonthYear
Date
Should be Empty: