Registration Form for the 1st Fleet Reserve Association Poker Run/Fun Run. Saturday December 3rd 2011.

Hosted by Fleet Reserve Association 290.

Liability: In consideration of the acceptance of the right to participate, entrants ,and participants, by execution
of this entry form, release and discharge The Fleet Reserve Association, Fleet Reserve Association Branch 290,
Fleet Reserve Association Club 290 and anyone else connected with the management or presentation of the 1st
Fleet Reserve Association Poker Run/Fun Run from any and all known and unknown damages, injuries, losses,
judgments, and/or claims from any causes whatsoever that may be suffered by any entrant to his/her person or
property.

Name (print) _______________________________________

Passenger

_______________________________________

Address____________________________________City__________________State_____Zip_______
E-Mail _________________________________________________
Signature___________________________________________Date_______________
Signature___________________________________________Date________________
Day of the Run

Rider/Driver

Pre-Registration
Prior to 26 Nov
$15.00

Passenger $10.00/$15.00

$_________

$_________

Total amount:

$_________

$_________

$20.00

Received by: _______________________________________ Date: ___________

Cut here return top portion

This is your receipt bring it with you to the poker run as proof of payment
Poker Run is open to all motorcycles (350cc+) and vehicles (cages).
Entry Fee:
Pre-registration $15.00 rider/driver postmarked by November 26th
($20.00 day of Poker Run)
All passengers $10.00 ($15.00 day of Poker Run)
Make checks or money order payable to:
Amount received: $ _________

FRA 290
Memo: Poker run

Form: cash / check/ money order

Received by: _________________________ Date: ___________

Fleet Reserve Association 290 is located at:

390 Mayport Road, Atlantic Beach, FL, 32233. (904) 246-6855