2010 

Whole Hawg Poker Run

     Official Entry Form

RULES                                _____________________________________

Name

_____________________________________________

Address

_____________________________________________

 City                               State                                  Zip

_____________________________________________

Phone

T-Shirt Size (Circle One):

S               M              L                 XL             XXL      3X

Sex (Circle One):          Male        Female

Age on Run Day:  ______________________________

Check One:

   □ $200 (without 6th card)            □ $225 (includes 6th card)

Payment by (check one):

   □Visa/Mastercard     □Check/Money Order/Cash

   Card # ________________________   Exp. _______

   Security Code: _____ (3 digit number on back of card)

 WAIVER:  I hereby release and hold harmless the Eufaula Area Chamber of Commerce, its officers, agents, and/or employees, other participants, sponsors or advertisers of any and all injury, disability, death or loss or damage to person or property arising from negligence to the fullest extent permitted by law.  By my signature, I verify that I understand this release and all rules associated with the event.

____________________________________________

Signature                                                          Date

____________________________________________

E-mail Address

Print out the poker run entry form and mail it to:

Eufaula Area Chamber of Commerce

P. O. Box 738

Eufaula, OK 74432