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CHICAGO POWERBOAT CLUB
PRESENTS
THE CHICAGO POKER RUN 2005
JULY 22-23, 2005
Robert Pastrick Marina – Resort’s Casino
East Chicago, Indiana
$395 for 2 People and $75 for each additional person
Proceeds to benefit




Resort's Hotel & Casino at Pastrick Marina
219/378-3229 Georgia
For more information and registration please visit
www.chicagopokerrun.com
708-207-6555




CHICAGO POWERBOAT CLUB
2005 CHICAGO POKER RUN APPLICATION

JULY 22-23, 2005
Robert Pastrick Marina – Resorts Casino
East Chicago, Indiana
(Due to Indiana regulations no one under the age of 21 will be allowed on Casino property)
(Let us know if you have anyone attending that is under 21 so we can make dinner arrangements at the Marina)
$395 for 2 People and $75 for each additional person
Proceeds to benefit Children’s Memorial Hospital

First Name: ____________________________________ Last Name: _______________________________________

Crew Mate’s First Name: _________________________ Last Name: ______________________________________

Address: ____________________________________City: ______________________ St ______ Zip____________

Home Phone: ________________________________ Fax # ______________________________________________

E-mail: _____________________________________ Cell # ______________________________________________

Boat Name: _______________________________ State ______ Reg. # or USCG Doc# ________________________

Boat Colors/Identifying Marks: __________________________________________________ ____________________

Hull Year: _____ Make: _________________ Model ________________ Length ______ Beam: _____ Draft: ______

Engine(s) 1, 2, 3, 4 Yr: ____ Make: __________________ CID: _______ HP (ea.): _______ Drive(s) ____________

Boat Insured by: _____________________Policy Number ____________________Phone #_____________________
(Important: Please enclose or fax a copy of your boat insurance policy, showing coverage)
__________________________________________________ _____________________________________________

Poker Run entry includes one Polo shirt, two T-shirts, a one year subscription to Extreme Boats Magazine, meals for two and one card hand. Entry Fee $395.00 Polo shirt size____ T-shirt captain size____ 1st Mate size____

Additional Crew Members $75.00 each (includes meals and one T-shirt) $75.00 X ______ = $_______
Crew shirt sizes: 1._____ 2._____ 3._____ 4._____ 5._____ 6._____ 7._____ 8._____ 9._____ 10. _____ 11._____
Additional clothing to purchase:
Item Small Medium Large XL XXL XXXL Cost Each Total
Polo Shirt $25.00
T-Shirt $15.00
Total

Will you be trailering your boat to Robert Pastrick Marina: Yes____or No____
What day will you be leaving the marina?_______

Signed: ______________________________ Date: _________________________
A release of liability and disclosure will be provided at the event. This release must be signed by the captain and all crew members. Those who fail to agree to the terms of the release/disclosure as well as provide proof of valid insurance will not be allowed to participate in the event.
Please make checks payable to:
Chicago Powerboat Club P.O. Box 06341, Chicago, IL 60606
312-281-5230 312-281-5231 FAX
[email protected]
www.ChicagoPokerRun.com
No refunds, returns, or cancellations