Specialty Watercraft Charity Poker Run Registration

 

 

First Name:__________________  Last Name:_______________________________

Address:_______________________________________________________________

City:_________________________________  State:__________  Zip:_____________

Phone:_____________________  Email Address:______________________________

 Captain & Craft  (Includes 1 Poker Hand):  _____ @ $50.00 each = _______

Passenger (Includes no Poker Hands):  _____ @ $10.00 each = _______

Number of Additional Poker Hands:     _____ @ $20.00 each = _______

                                                                                                                        Total:$__________

This registration is invalid unless rider/passenger(s) accept release agreement.

I understand and acknowledge that involvement in the Specialty Watercraft Charity Poker Run involves calculated risks to life and limb. However, I accept the risks of this activity and I hereby release, and will indemnify and hold Specialty Watercraft  and event organizers,  their officers, staff, volunteers, promoters, sponsors, participants, agents, representatives and all other persons harmless from and against all claims, demands, liability, loss, damages, costs and expenses (including attorney fees) and all other liability of every type and character, including but not limited to claims for injuries to property or persons (including crippling or disfiguring injury or death), arising from, or incurred as a result of my participation in the Specialty Watercraft Charity Poker Run, and I fully assume and accept all associated risks.

I have read and understand the rules of this event.

  I Agree                 Rider Signature:_________________________________

 

                                    Passenger Signature:_______________________________

 

Rider: _______________________________

T-shirt size: S M L XL XX XXX (circle one)

 

Passenger: _____________

T-shirt size: S M L XL XX XXX (circle one)