Name *

Address *

Telephone Number

E-mail *

Any suspected breeding source in your area? (eg: crop waste or recent application of manure)

Comments (eg. describe impact on outdoor activities) (250 chars left)

Is this a long term outbreak? Yes No

If so, please enter the details (250 chars left)

Rating of Severity of Flies (* see below for details) 1 2 3 4

Date of Notification ... *

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Thank you for the Notification! A copy of your completed form has been sent to your nominated e-mail address. We will contact you as soon as possible.

Shire of Gingin
Administration