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.
Registrations after 1st August will default to WHITE CLASS, (no meals) and a $10 surcharge will apply for late resgistration.
Please note, you will not be guaranteed a shirt, and no discounts will be given if there are no shirts available.
Class *
Shirt Size: *
Payment: Direct Deposit Only. Acc Name: Southern Cross Association (FTC) Inc.
Bank: Bendigo BSB: 633000 Acc No.: 128514205 Your Ref: Surname
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.
Willing to help with meals, bar, activities etc?
Powered byFormsite