Application to Enter and/or Remain on Anangu Pitjantjatjara Land Pursuant to the Pitjantjatjara Land Rights Act (1981) Anangu Pitjantjatjara PMB 227 Umuwa via Alice Springs NT 0872 Tel: (08) 8950 1511.  Fax: (08) 8950-1510

NOTE: $10 per person PERMIT FEE applies NOTE: It is important that you clearly PRINT all details on this form Office Use Only Permit No. ______________ Fee Paid?:       Yes/No Receipt/Invoice No: _______________________

NAME(S) OF APPLICANTS 1.   ________________________________________________________________ 2.   ________________________________________________________________ 3.   ________________________________________________________________ 4.   ________________________________________________________________ ORGANISATION & POSITION ____________________________________________ STREET/P.O. BOX NUMBER _____________________________________________ CITY ___________________________________   POSTCODE ________________ TELEPHONE __________________________   FAX _________________________ PURPOSE OF ENTRY __________________________________________________ ____________________________________________________________________ DATES OF ENTRY:     FROM: _______________ TO: ________________

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Amata		Umuwa		Walatina
Nyapari		Tjurma Homelands		Iwantja (Indulkana)
Murpatja Homelands		Pukatja (Ernabella)		Mimili
Angatja		Anilalya Homelands		Pipalyatjara
Kaltjiti (Fregon)		Watinuma		Pitj. Homelands
Irintata Homelands		Wawi Homelands		Watarru
Yunyarinyi (Kenmore Park)		Turkey Bore / Tjutjinpiri Homeland

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COMMUNITY APPROVAL

Signature _______________________________ Position _______________________________