The 5th Annual Charity Poker Tournament Registration

When: August 7th, 2010 @ 6:00pm (Registration & Dinner begin @ 5pm)
Where: TBD
Cost: Only $125 - Includes food and beverages! (Limited guests at a cost of $40)
Prizes: Details to come!

Fields marked * are required.
For 2 or more registrants, please register the credit card holder first.

Players:*
$125 each
($150 after July 25th)		 1
2
3
4
5
First Name:*
Last Name:*
Company:
Address:*
City:*
State:*
Zip Code:*
Phone: *
Alt. Phone:
Email:*
Gender:* Male Female
Guests for this player:
$40 each (max. 3 per player, space is limited)
Guest Name(s):

How did you hear about this event?*
Where, Who, or Which One?