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Poker Run Registration
2022 Poker Run Registration
Pilot Name
*
First
Last
Email
*
Seaplane Information
There is no airfield access at the Poker Run stops. A seaplane or amphibious aircraft is required for participation.
N-Number
*
Seaplane Make and Model
*
Aircraft Color Scheme
Participant Information
Is the Pilot Playing?
Yes
No
Number of Hands for Pilot
1 - $100
2 - $150
3 - $200
4 - $250
Pilot's Unisex T-Shirt Size
Small
Medium
Large
X-Large
XX-Large
Register Additional Players in Plane
Number of Additional Participants
Please enter a number from
0
to
5
.
Additional Player #1
Name of Additional Player #1
First Name
Last Name
Email Address for Additional Player #1
Number of Hands for Player #1
1 - $100
2 - $150
3 - $200
4 - $250
Player #1's Unisex T-Shirt Size
Small
Medium
Large
X-Large
XX-Large
Additional Player #2
Name of Additional Player #2
First Name
Last Name
Email Address for Additional Player #2
Number of Hands for Player #2
1 - $100
2 - $150
3 - $200
4 - $250
Player #2's Unisex T-Shirt Size
Small
Medium
Large
X-Large
XX-Large
Additional Player #3
Name of Additional Player #3
First Name
Last Name
Email Address for Additional Player #3
Number of Hands for Player #3
1 - $100
2 - $150
3 - $200
4 - $250
Player #3's Unisex T-Shirt Size
Small
Medium
Large
X-Large
XX-Large
Additional Player #4
Name of Additional Player #4
First Name
Last Name
Email Address for Additional Player #4
Number of Hands for Player #4
1 - $100
2 - $150
3 - $200
4 - $250
Player #4's Unisex T-Shirt Size
Small
Medium
Large
X-Large
XX-Large
Additional Player #5
Name of Additional Player #5
First Name
Last Name
Email Address for Additional Player #5
Number of Hands for Player #5
1 - $100
2 - $150
3 - $200
4 - $250
Player #5's Unisex T-Shirt Size
Small
Medium
Large
X-Large
XX-Large
Summary
Total Cash Due at Sign-In
Release
*
I agree to hold Wipaire harmless from any and all claims, loss or damage to my personal property, liabilities and costs, including attorney’s fees, as a result of my participation in this Activity, including travel to and from the Activity (including air travel) or any events incidental to this Activity. If Wipaire incurs any of these types of expenses, I agree to reimburse Wipaire I am confirming I am above 18 years of age at the time of online registration for this event. I understand that there are risks associated with my participation in this Activity, such as physical and/or psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability, death or economic loss. These injuries or outcomes may arise from my own or other’s actions, inactions, or negligence, or the condition of the Activity location (s) or facility(ies). Nonetheless, I assume all risks of my participation in this Activity, whether known or unknown to me, or any events incidental to this Activity.