2012 Texas Hold'em Charity Tournament Registration Form

MUST BE 21 OR OLDER TO PLAY

Player #1 Name:
Address:
Phone:
Email:
Player #2 Name:
Address:
Phone:
Email:
	Register by March 10, 2012
$60 Individual	$110 Couple
	Register after March 10, 2012
$70 Individual	$130 Couple
Payment Method:	Mail Check Online