Danbury Fire Fighter's Association Poker Run Registration Form

THIS FORM MUST BE FILLED OUT FOR EACH RIDER

Name:

Address:

City:

State:

Zip:

Phone:

E-Mail

Please provide a vaild email address, all registrations will be confirmed by email.

T-shirts are not included in the entry fee but will be available for purchase.  They will be on a first come - first serve basis.  They are $8.00 for Medium to XL, $9.00 for XXL and $10.00 for XXL.  To make sure you get your T-shirt, Please select your size below.

T-Shirt Size

I do not want a T-shirt

Medium

Large

X-Large

XX-Large - $9.00

XXX-Large $10.00

Additional Comments

I HAVE READ THE FOREGOING STATEMENT ON THE PREVIOUS PAGE AND UNDERSTAND ITS TERMS AND FREELY AND VOLUNTARILY SIGN THE SAME. I UNDERSTAND THAT BY SIGNING THIS FORM I AM GIVING UP MY LEGAL RIGHTS AND/OR REMEDIES WHICH MAY BE AVAILABE TO ME.

After you submit this form, please print out the page and send payment to: Poker Run Danbury Fire Fighter's Association 201 Main St Danbury, IA 51019 If you ordered a t-shirt make sure you include that with your $15.00 entry fee. Make Checks payable to Danbury Fire Fighter's Association If you have multiple applications, they can be paid with one check