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Southern Cross Association Annual 5 Day Poker Run Starts 1st Monday in September Name: Address: Email: This section is optional. Note: Blue cards are required when giving rides or Marshalling, as per our Duty of Care Procedures Blue Card Holder Willing to give rides at camping grounds / schools Willing to be a Marshal for rides. Registrations after 1st August will automatically default to WHITE CLASS (+ $10 sur - charge). No meals will be available after this date. Office use only Total Amount: $ Payment: Cheque or money order made out to Southern Cross Association and sent to address below, This form must be submitted by mail: Southern Cross Poker Run 162-172 Honeyeater Drive, Greenbank Qld 4124 Rec No PR No Comment Long sleeve and 4XL and larger to be ordered by 30 June Shirt Size: S M L XL 2XL 3XL 4XL 5XL 6XL 7XL If not registered before 1st August, Please add surcharge of $10 to White Class. No meals will be available after 1st August. All nominations include Poker Run t-shirt, badge & camping. RED CLASS: Poker Hand, Dinners & Breakfasts ........................$300.00 BLUE CLASS : Poker Hand & Dinners ......................................$260.00 GREEN CLASS : Poker Hand & Breakfasts................................$220.00 WHITE CLASS : Poker Hand only (no meals) ............................$150.00 Long sleeve ($10 extra) Mob Phone:

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Southern Cross AssociationAnnual 5 Day Poker Run Starts 1st Monday in September

Name:

Address:

Email:

This section is optional. Note: Blue cards are required when giving rides or Marshalling, as per our Duty of Care Procedures

Blue Card Holder Willing to give rides at camping grounds / schools Willing to be a Marshal for rides.

Registrations after 1st August will automatically default to WHITE CLASS (+ $10 sur--charge). No meals will be available after this date.

Office use only

Total Amount: $

Payment: Cheque or money order made out to Southern Cross Association and sent to address below,

This form must be submitted by mail: Southern Cross Poker Run 162-172 Honeyeater Drive, Greenbank Qld 4124

Rec NoVerified

PR NoComment

Long sleeve and 4XL and larger to be ordered by 30 JuneShirt Size: S M L XL 2XL 3XL 4XL 5XL 6XL 7XL

If not registered before 1st August, Please add surcharge of $10 to White Class. No meals will be available after 1st August.

All nominations include Poker Run t-shirt, badge & camping.

RED CLASS: Poker Hand, Dinners & Breakfasts ........................$300.00 BLUE CLASS: Poker Hand & Dinners ......................................$260.00 GREEN CLASS: Poker Hand & Breakfasts ................................$220.00 WHITE CLASS: Poker Hand only (no meals) ............................$150.00

Long sleeve ($10 extra)

Mob Phone:

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Cheque No.:
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Only fill this form out if you are posting with cheque/money order
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