Personal Details Name: Organisation: If you will be representing an organisation, please attach a letter confirming this from the organisation. Address: Phone Number: Email: L&OWMP: Lake Eppalock Cairn Curran Reservoir Lake Buffalo Lake William Hovell Lake Boga Kow Swamp Selection Criteria What is your understanding of the content of the relevant Land & On Water Management Plan and the role of the implementation group? What is your reason for wanting to join the Land & On Water Management Plan Implementation Group? What experience, skills and abilities would you bring to the committee if selected? Do you have pecuniary interests relevant to the implementation group or any of the stakeholder agencies involved?

October 2015

If selected, I agree to abide by all GMW policies and procedures associated membership of the Implementation Group. Yes No These policies and procedures can be found at: www.gmwater.com.au/customer-services/lowmp. Please email your completed form to Fabian.McCloy@gmwater.com.au. Please attach any relevant supporting documents (resume, cover letter or letter or endorsement if representing an organisation) to your email. Should you have questions, please contact Fabian McCloy on (03) 5826 3781.