REGISTRATION POKER RUN

REGISTRATION | Poly Lift

August 22nd, 2025

CAPTAIN | FIRST NAME

CAPTAIN | LAST NAME

Multi-line address

Country/Region

Address

City

Zip / Postal code

Phone

Email

CAPTAIN | AGE

CAPTAIN | GENDER

Male

Female

FIRST MATE | FIRST NAME

FIRST MATE | LAST NAME

FIRST MATE | AGE

FIRST MATE | GENDER

Male

Female

Poker Run Captain & First Mate

$450

Extra Hands

1 Extra Hand$75

2 Extra Hands$150

3 Extra Hands$225

4 Extra Hands$300

5 Extra Hands$375

6 Extra Hands$450

7 Extra Hands$525

8 Extra Hands$600

9 Extra Hands$675

10 Extra Hands$750

Signature

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Rain or Shine Event. Non-Refundable Registration

I agree to the rules and regulations on the Poly Lift Poker Run(Linked below)