FLORIDA POWERBOAT CLUB –Tampa Bay Poker Run . Page 1 of 2
March 22-25, 2018
Member Name: ______
Boat Name-Make: ______ New boat? Y / N
Email: ______ Zip code: ______
Cell Phone: ______Fax: ______
Names of Crew: Please indicate t-shirt sizes. Crew names are very important (video, etc…)
Captain: ______1st Mate: ______
T-shirt size: S M L XL XX (circle one) T-shirt size: S M L XL XX (Ladies Tank)
Crew 1: ______Crew 2: ______
T-shirt size: S M L XL XX (Ladies Tank) T-shirt size: S M L XL XX (Ladies Tank)
Crew 3: ______Crew 4: ______
T-shirt size: S M L XL XX (Ladies Tank) T-shirt size: S M L XL XX (Ladies Tank)
Crew 5: ______Crew 6: ______
T-shirt size: S M L XL XX (Ladies Tank) T-shirt size: S M L XL XX (Ladies Tank)
______
Event fees DO NOT INCLUDE accommodations or dockage.
*Note: Late fees of $100 will be added for registrations received after February 22, 2018
Event Fee (Captain & mate): $800 ……...….……...….……...……...……...….. $______
Extra crew: ______x $175 Includes event tee and function passes……….. $ ______
Additional T-shirts or Ladies tanks $20.ea…………..………………………… $ ______
Tee Sizes: ___S ___M ___ L ___XL ___XX - Ladies tanks: ___S ___M ___L
Additional Event Videos DVD ($30) ___ ……………………………..………..... $ ______
Safety Management Fund: ____ $50 for boats running 45 – 60mph
___$100 boats 60-99mph ____$150 boats 100+ …….... $ ______
Other Charges/credits: ……………………….………………………..…..…… $ ______
Total Payable: ...………….…...... $ ______
FEES PAYABLE TO: FLORIDA POWERBOAT CLUB: 1214 SW 6th St. Pompano Beach, FL 33069 Event Fees may be paid by: (Please Check One)
*Amex* M/C* VISA* Discover* Check
Card#: ______Exp: ______CVV: ______
Name: ______Signature: ______Date: ______
No returns or refunds on cancellations. Credit policy applies to all prepaid event fees
PLEASE FAX FORM TO (954) 782-2452 or email
CONTACT FLORIDA POWERBOAT CLUB FOR MORE INFORMATION: Weekdays 10AM – 5PM
' (954) 545-1414 - 6 Fax (954) 782-2452 - www.FLPOWERBOAT.com
FLORIDA POWERBOAT CLUB – Tampa Bay Poker Run 2018
Docking and Accommodations - Reservation Form
Member Name: ______Date: ______
Note: A copy of your insurance declaration page must accompany this registration.
Club Membership is necessary to participate on this event. Do you need membership information? Y / N
Destination Hotel and Marina– Rates Subject to Change
Tampa Marriott Waterside Hotel & Marina Number of rooms: ______
Waterfront View $265 ______King ______Double
Limited Private Floating slip $3.50 per ft: Yes / no
The Westin Tampa Waterside Number of rooms: ______
Luxury Suite Water view $320 ______King ______Double
Studio Suite $295 ______King ______Double
Traditional $220 ______King ______Double
Check in______Thursday March 22 or ______Friday March 23 (Check out is Sunday March 25)
Special Needs:______
Rafting Slips $3.00 per ft Y / N
Yacht Slips with power– Flat rate $1000 Y / N
Credit Card Info - *Amex* M/C* VISA* Discover* Check
Card#: ______Exp: ______
Name: ______Signature: ______Date: ______
No returns or refunds, cancellations. Credit policy applies to all prepaid event fees
PLEASE FAX FORM TO (954) 782-2452 or email