AUSTRALIAN DARK SKY REGISTER
DARK SKY TOWN NOMINATION FORM
USE THIS FORM WHEN NOMINATING A DARK SKY TOWN (NOT A SITE)
ORGANISATION INFORMATION
NAME OF ORGANISATION OR GROUP: ……………………………………………………………………………………
CONTACT PERSON: ……………………………………………………………………………………………………………
POSITION IN ORGANISATION: ………………………………………………………………………………………………..
POSTAL ADDRESS: ……………………………………………………………………………………………………………..
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TELEPHONE: …………………………………………… EMAIL: ……………………………………………………………
WEBSITE: …………………………………………………………………………….
DARK TOWN INFORMATION
TOWN NAME: …………………………………………………………………………………… STATE: …………………
TOWN CO-ORDINATES (lat/long): ……………………………………………………………………………………………..
DARKNESS LEVELS IN PUBLIC PARKS/SPORTS GROUNDS ETC (see Criteria notes): ………………………..…
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SQM READINGS (if known): …………………………………………………………………………………………………….
DESCRIPTION OF SITES: ……………………………………………………………………………………………… ………
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OPEN PUBLIC ACCESS (yes/no): ………………………… RESTRICTED ENTRY (yes/no): ………………………...
IF RESTRICTED ACCESS PLEASE EXPLAIN PUBLIC ACCESS ARRANGEMENTS: ……………………………….
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DISABILITY ACCESS (yes/no): ………………… PUBLIC TOILET ACCESS (yes/no): ……………………..
DOES ANYONE HOLD STARGAZING EVENTS AT THESE SITES (yes/no): ……………………..
IF YES, PLEASE EXPLAIN: ……………………………………………………………………………………………………
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SUPPORTING INFORMATION
ACTION BEING TAKEN BY YOU OR YOUR ORGANISATION TO REDUCE LIGHT POLLUTION, AND TO PREVENT FURTHER INCREASE IN LIGHT POLLUTION, IN YOUR TOWN:
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FURTHER COMMENTS TO ASSIST IN YOUR NOMINATION: ……………………………………………………………
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Signature of above named applicant ............................................................................................................... Date: .....................................................
PLEASE INCLUDE COPIES OF ANY DOCUMENTATION LISTED IN THE CRITERIA WITH YOUR APPLICATION
DARK SKY TOWN NOMINATION FORM
USE THIS FORM WHEN NOMINATING A DARK SKY TOWN (NOT A SITE)
ORGANISATION INFORMATION
NAME OF ORGANISATION OR GROUP: ……………………………………………………………………………………
CONTACT PERSON: ……………………………………………………………………………………………………………
POSITION IN ORGANISATION: ………………………………………………………………………………………………..
POSTAL ADDRESS: ……………………………………………………………………………………………………………..
……………………………………………………………………………..................... POSTCODE: ………………………..
TELEPHONE: …………………………………………… EMAIL: ……………………………………………………………
WEBSITE: …………………………………………………………………………….
DARK TOWN INFORMATION
TOWN NAME: …………………………………………………………………………………… STATE: …………………
TOWN CO-ORDINATES (lat/long): ……………………………………………………………………………………………..
DARKNESS LEVELS IN PUBLIC PARKS/SPORTS GROUNDS ETC (see Criteria notes): ………………………..…
………………………………………………………………………………………………………………………………………
SQM READINGS (if known): …………………………………………………………………………………………………….
DESCRIPTION OF SITES: ……………………………………………………………………………………………… ………
………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………
OPEN PUBLIC ACCESS (yes/no): ………………………… RESTRICTED ENTRY (yes/no): ………………………...
IF RESTRICTED ACCESS PLEASE EXPLAIN PUBLIC ACCESS ARRANGEMENTS: ……………………………….
………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………
DISABILITY ACCESS (yes/no): ………………… PUBLIC TOILET ACCESS (yes/no): ……………………..
DOES ANYONE HOLD STARGAZING EVENTS AT THESE SITES (yes/no): ……………………..
IF YES, PLEASE EXPLAIN: ……………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………...
SUPPORTING INFORMATION
ACTION BEING TAKEN BY YOU OR YOUR ORGANISATION TO REDUCE LIGHT POLLUTION, AND TO PREVENT FURTHER INCREASE IN LIGHT POLLUTION, IN YOUR TOWN:
……………………………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………….
……………………………………………………………………………………………………………………………………….
……………………………………………………………………………………………………………………………………….
……………………………………………………………………………………………………………………………………….
……………………………………………………………………………………………………………………………………….
FURTHER COMMENTS TO ASSIST IN YOUR NOMINATION: ……………………………………………………………
……………………………………………………………………………………………………………………………………….
……………………………………………………………………………………………………………………………………….
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Signature of above named applicant ............................................................................................................... Date: .....................................................
PLEASE INCLUDE COPIES OF ANY DOCUMENTATION LISTED IN THE CRITERIA WITH YOUR APPLICATION
PLEASE PRINT OUT (right click/print) AND COMPLETE THE ABOVE NOMINATION FORM AND
POST WITH ALL DOCUMENTATION TO:
AUSTRALIAN DARK SKY REGISTER
2/323 Endeavour House
Captain Cook Crescent
Manuka, 2603
ACT
NOTE:
- NO FEES ARE REQUIRED TO REGISTER ON THE AUSTRALIAN DARK SKY REGISTER
- ANY COSTS FOR SIGNAGE ARE THE REGISTERED MEMBERS RESPONSIBILITY
- ADSR MEMBER LOGO MAY BE PLACED ON REGISTERED MEMBERS WEBSITES, LETTERHEADS ETC
- ANY ADSR LOGO USED ON MEMBERS WEBSITES MUST LINK BACK TO THIS ADSR WEBSITE
- NON-REGISTERED GROUPS, ORGANISATIONS OR INDIVIDUALS MUST NOT USE THE NAME, ARTWORK, NAME, SIGNAGE OR LOGO OF THE ‘AUSTRALIAN DARK SKY REGISTER’
