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Leave No Trace Application
Owners Name (1) :
Owners Name (2) :
CMCA # :
Vehicle Rego # :
Postal Address:
Suburb:
State :
Postcode :
Mobile phone # :
Vehicle Make :
 Eg. Fiat, Mercedes, Mazda, Iveco, Toyota
 
Vehicle Model # :
 Eg. EDI2000, Coaster , Transit
 
Conversion/ Manufacturer:
 Eg. Sunliner, Winnebago, Swagman
 
Year of Manufacturer::
Fresh Water :
 Does your vehicle carry a minimum of 20 litres of fresh water?
  No Yes Capacity (L)
Grey Water :
 Does your vehicle carry a minimum of 10 litres of grey water (30 litres if fitted with shower)?
  No Yes Capacity (L)
Black Water :
 Does your vehicle have a portable toilet or black water holding tank?
  No Yes Capacity (L)
Solid Waste :
 Does your vehicle have a means of storing garbage?
  No Yes  
Shower :
 Does your vehicle have a shower?
  No Yes  
Please note: You must be able to verify the information you have supplied on this Application form at any time at the request of any controlling authority (eg. Council Ranger), or by a representative of the Regulating Authority of this Scheme.

Declaration

I/we hereby declare that the information I/we have supplied in this application form is true and correct. I/we declare the accuracy of these particulars and that I/we am/are the owner/s of the vehicle described herein. I/we agree that if any information that I/we have disclosed on this application is found to be false or misleading, or if I/we breach any provisions of the Code of Conduct or rules associated with the programme, my/our privileges under this programme may be withdrawn.
Do you agree to the Declaration of Terms and Conditions? Yes

Inspectors are available to assist you if necessary. Please contact CMCA (02) 4978 8788
The Regulating Authority of the Leave No Trace Self Containment Code of Conduct Scheme is the Leave No Trace Committee of the Campervan and Motorhome Club of Australia Ltd.
ABN 16 095 568 157 49 The Avenue, Wickham NSW 2293 (02) 4978 8788