For the purposes of section 17C(2)(a) of the Act, the prescribed particulars for an application for a rodeo licence are—
(a) the full name of the applicant;
(b) the street and postal address of the applicant;
(c) a contact telephone number and email address (if any) for the applicant;
(d) the name of the approved rodeo organisation that the applicant is accredited with;
(e) the date that the form was signed by the applicant.