Aboriginal ownership *

100% Aboriginal owned

More than 51% Aboriginal owned

Less than 50% Aboriginal owned

Phone *

(###)

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Does the business have Public Liability insurance? *

Yes

No

Business owner *

First Name

Last Name

Business owner phone *

(###)

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Is the business owner a member of the Karri Karrak Aboriginal Corporation? *

Yes

No

Date form completed *

MM

DD

YYYY