Time and Place:
Sunday, July 23, 10:30 AM
Latus Motors, 870 E. Berkely St., Gladstone, OR

Poker Run Poster cropped

You can print and mail this form (use "gear" icon above right to print)

Name of driver________________________________________________ $40
(includes one poker hand, lunch and a t-shirt)
  S   M   L   XL  (circle size please)

Name of passenger____________________________________________ $25
(includes one poker hand, lunch and a t-shirt)
  S   M   L   XL  (circle size please)

Additional poker hand(s): Number of additional hands ___________x $10 = _____________ $_____

Just Lunch(es) without the ride: Number of lunches ___________ x $10=______________ $_____

Additional t-shirt and lunch: Name ______________________________ ________ x $25=_______________ $_____
  S   M   L   XL  (circle size please)

Additional donation $_____

Total check amount $_____ 

Phone number______________________

I have read and accept the (click here) accident waiver, release of all liability and assignment of claims on the attached PDF.

Print name_____________________________ Signature______________________________ Date_________

 

Mail printout of completed Registration form and check to:
Come Rest Awhile, PO Box 1116, Lake Oswego, OR 97035

Or, please use this button to



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