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.
Meals and shirts must be ordered and paid for by 31 July. We have to preorder them.
If you order after this date we'll try but cannot guarantee you meals or a shirt in your size. 
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.SurnamePR21
Current Total:
This section is optional. Note: Blue cards are required when marshalling or giving rides to children.
Are you able to help with cards, meal sheets, or other activities at the campsites?
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