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.
T-shirts can no longer be ordered but some may be available.
No meals will be available after 1st August.
Class *
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.
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