Authorisation to confirm a valid card/application
This form is to be completed by applicants/cardholders who have applied for, or hold a blue/exemption card to advise they are undertaking child-related activities with a new or additional organisation.
Poker Run 2017 form-Printable for payments by cheque/money order/cash only

Print for posting with cheque/money order payments ONLY.

DO NOT submit this form via email if you intend to pay via direct debit.

PLEASE READ BEFORE FILLING OUT FORM

Submit online for Direct debit payments ONL

DO NOT submit this form via email if you intend to pay by cheque/money order.

PLEASE READ BEFORE FILLING OUT FORM

Submit online for Direct debit payments ONLY

DO NOT submit this form via email if you intend to pay by cheque/money order.

IMPORTANT: If you have not received confirmation of your submission and payment within 14 working days, please email concretemusic1@hotmail.com. It is your responsibility to ensure your form and/or payment has been received.

 

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