First Name *

Last Name *

Position *

Company Name *

Phone Number *

ABN *

ABN (optional) 

Year graduated *

Registration Number *

Street Address *

Address Line 2 

Town / City *

Country and State *

Australia

Select an option…Australian Capital TerritoryNew South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia

Postcode / ZIP *

Drug & Chemical License held (optional) 

Property Identification Code (PIC, optional) *

Vet Name (optional) 

Lamb Marking Month Aprox (optional) 

Approximately how many lambs do you mark per year? 

Qualifications *

Please include with your completed application a photo of the Veterinary Surgeons certificate of registration for the above named person responsible for ALL scheduled drugs purchases. We require a current certification that shows an expiration date. Accepted file types: pdf, jpg, png, jpeg. Max. file size: 256 MB. 
Supported file types: jpg, jpeg, png, txt, pdf, doc, docx

If you have your certificate of registration on iCloud, Google Drive or Office 365 then you can paste the link here 

I would like my location being shown on a public map so sheep farmers can find me as a NumOcaine reseller. *

I agree