Online Poker Tournament Registration
This Order Form is Secure
Date: 2/4/2012   
Personal Information
Your Name
Address
City
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Email
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Date of Birth mm/dd/yy
Please Check One:

High Card $300.00 (Single Player Entry)
Pair $600.00 (two players)
Four of a Kind $1200.00 (four players)
Banner $500 (single banner placement)
Flush $2000 (4 players and 2 banners)
Royal Flush $12,500.00 (Title sponsorship of event)

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Name of Sponsorship(s) if applicable:
Comments::
Payment Information

Payment will be accepted at the cashier cage at the MGM Grand Las Vegas, the day of the tournament. Cash and Checks accepted
 (* A donation receipt will be mailed to your address listed above)
The Road 2 Recovery Foundation is recognized by the U.S. Government as a not-for-profit charity foundation that meets the 501c-3 requirements.
Our charitable tax ID number is: 86-0996104