Four Horsemen Poker Run on Lake Winnebago

2012 - SIGN UP FORM

Please indicate what class you will be running in:
80 Mph Class 79 MPH and lower

Captain's Name
Street Address:
City, State, Zip
Phone Number: Email:
Name of Boat: MFG and Year
Boat Length Boat Width:
Boat Insurance Provider:
Please bring along a copy of your insurance, email or fax a copy to us - 920-232-3601

Shirt Size: (S, M, L, XL and XXL, Specify Man or Woman size)

Co-Pilot Name:
Street Address:
City, State, Zip
Phone Number: Email:
Shirt Size: (S, M, L, XL and XXL, Specify Man or Woman size)

Add'l Crew Member Name:
Street Address:
City, State, Zip
Phone Number: Email:
T- Shirt Size: (S, M, L, XL and XXL, Specify Man or Woman size)

Add'l Crew Member Name:
Street Address:
City, State, Zip
Phone Number: Email:
T- Shirt Size: (S, M, L, XL and XXL, Specify Man or Woman size)

Additional Clothing Purchase: Please indicate size and quantity
Shirt Size: Quanitity x $30 = Total $
T-Shirt Size: Quanitity x$30 = Total $

Nights a slip is needed / $1.50 per ft. / per night: No minimum stay required
No slip needed Fri. night slip Sat. night slip Fri & Sat. night slip

Send the form: