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.
Class *
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.
Are you able to help with cards, meal sheets etc at the campsites?
Powered byFormsite