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SOUTHERN CROSS CLUB
PO BOX 19243
WASHINGTON, DC  20036-9243
MEMBERSHIP APPLICATION/RENEWAL
WWW.SOUTHERNCROSSCLUBDC.COM
Southern Cross Club Washington DC Application Form

The purpose of the Southern Cross Club, founded in Washington, DC in 1946, is to promote and further friendship among the nationals of Australia, New Zealand, and the United States. We are honored in having as patrons the Australian and New Zealand ambassadors to the United States and their wives.

Membership is particularly invited from citizens and former residents of Australia or New Zealand, together with their families.

The Club membership year runs from 1 July through 30 June. Annual dues are $25.00 for a single membership and $30.00 for dual or family membership.

Name(s)                                                                         Nationality, or former nationality if citizen:

____________________________________                 _____AUS _____NZ _____US _____Other

____________________________________                 _____AUS _____NZ _____US _____Other

Dependent children under 21 years of age:                         Hometown: __________________________

____________________________________                 Phone Home:_________________________

____________________________________                 Phone Work:_________________________

Address:_____________________________                  E-mail:______________________________

____________________________________

____________________________________
                                                      Zip Code

Your name(s) will be printed in our Membership List, which is provided to all members.

May we print your telephone number?  _______Yes   _____No

Type of membership requested:  _____Single $25.00  _____Family $30.00

Signature:______________________________________________  Date:_____________________

Please send the completed application with check to the SOUTHERN CROSS CLUB for the amount corresponding to the type of membership desired, to the club’s address shown above.