Southern Cross Annual 5 Day Poker Run Registration Form

Please DO NOT fill out this form if you are paying by cheque/money order or cash.
Long Sleeve shirts and shirt sizes 4XL and up must be ordered by 30th June.
If not registered before 1st August, a surcharge of $10 will be added to White Class. No meals will be available after 1st August.
Class *
Long Sleeve Shirt *
Shirt Size *
Payment: Direct Debit Only. Acc Name: Southern Cross Association (FTC) Inc.
Bank: Bendigo BSB: 633000 Acc No.: 128514205 Your Ref: Initial.SurnamePR19
Payment Options *
Current Total:
Blue Card (optional) This section is optional. Note: Blue cards are required when giving rides or Marshalling, as per our Duty of Care Procedures.
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