Southern Cross Association (FTC) Inc Membership Application

Please DO NOT fill out this form if you are paying by cheque/money order or cash.

All memberships are due on the 1st February each year.

Date: * +

Membership No.:

First Name *

Last Name *

Address *

City *

State *

Post Code *

Phone Number *

Email Address *

Membership Type *

New Membership including Badge - $20

Membership Renewal - $10

2 Years - $20

5 Years - $50

Date payment will be made: * +

Current Total:

$0.00

I give permission for my details to be on a contact for SCA Members only. *

Yes

Payment: Direct Debit Only. Acc Name: Southern Cross Association (FTC) Inc.
Bank: Bendigo BSB: 633000 Acc No.: 128514205 Your Ref: SurnameMS

Your membership application will be tabled and voted on at a National Management Committee
meeting. A membership acceptance notice will be a written notification via the National Newsletter and
when you receive your badge and/or membership card.
SCA has a public liability insurance policy to $20 000 000 which covers members and participants
involved in an event held by the Southern Cross Association (F.T.C.) Inc.

By clicking confirm on the next page, you have read and agree to the above statement.