Customer Request Management Entry
Instructions
You are a member of the public, please fill this form in.
Lake Broadwater Boating Registration
Welcome to the Lake Broadwater Boating and Watercraft Registration. The cost for registration is currently Free.
Registering for boating at Lake Broadwater is MANDATORY for all motored watercraft. Registration must be completed each day BEFORE your watercraft enters Lake Broadwater.
Date Boating at Lake Broadwater
(Required)
Boat Licensed Operator's Details
First Name
(Required)
Last Name
(Required)
Contact Phone Number
(Required)
Date of Birth
(Required)
Boat Licence Number
(Required)
Boat Licence Expiration Date
(Required)
Boat Information
Boat Make
(Required)
Boat Model
(Required)
Boat Registration
(Required)
Boat Registration Expiration Date
(Required)
3rd Party Insurance Details Information
Insurance Company
(Required)
Insurance Policy Number
(Required)
Insurance Policy Expiration Date
(Required)
Home Address Information
Street Address
(Required)
Suburb
(Required)
State
(Required)
Postcode
(Required)
Declaration
I Acknowledge and Agree to: 1) to comply with all laws, rules and regulations that apply to Lake Broadwater, and understand that infringements and/or penalties may be applied by
the Department of Transport and Main Roads, Department of Environment and Science, Maritime Safety Queensland and Western Downs Regional Council.
2) Western Downs Regional Council is collecting the personal information you supply on this form in accordance with Local Government Act 2009. The personal information collected on this form will be used to ensure compliance with Local Government Act 2009
and maintain a register of vessels using Lake Broadwater. Your personal information will be accessed by persons who have been authorised to do so. Your information will not be given to any other person or agency unless required by law.
Western Downs Regional Council may disclose the personal information collected on this form to the Lake Broadwater Caretakers for the purposes of ensuring compliance with the Local Government Act 2009 and collection on behalf of Council.
Your personal information will be handled in accordance with the Information Privacy Act 2009.
(Required)
- -Please Select- -
Yes
Additional Contact Information (Not Mandatory)
Enter a description of events/problem.
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