Boater’s Of Webster

2011 Webster Lake Poker Run - 8/20/11

REGISTRATION FORM

Entry Fees:

$35.00 - Captain:  Includes one (1) dinner and one (1) poker hand.  Only one (1) Captain per boat.

$15.00 - Dinner only

$25.00 - Poker Hand only

**CAPTAIN’S REGISTERED AND PAID BY 8/1/11 WILL GO INTO A DRAWING FOR A FREE ADDITIONAL POKER HAND.  UP TO 15 HANDS WILL BE AWARDED!** 

BOAT NAME/TYPE:

 

 

REGISTRATION #:

CAPTAIN’S NAME:

 

Address:

On-site cell #:

E-mail:

 

CREW

 

NAME  /  ADDRESS  /  PHONE #  /  E-MAIL

Paid:  Y/N?

#2:

 

 

 

#3:

 

 

 

#4:

 

 

 

#5:

 

 

 

#6:

 

 

 

I certify that the above-named boat is insured for the 2011 Poker Run events for Public Liability & Property Damage.

 Applicant’s Signature:  ____________________________________ Date:  ___________________

 Total Due:  $________      Total Paid:  $________      Balance Due:  $________     Checks payable to:  B.O.W.

 All forms and payment should be returned to:  Joanne Saad, 21 Perryville Rd., Webster, MA  01570; 508-949-1389; e-mail:  jsaad1028@aol.com

B.O.W. use only:

 

 

BOWregistration:  06/20/11

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