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FLORIDA POWERBOAT CLUB –KEY WEST POKER RUN ‘17
November 7-13, 2017
Member Name: ______
Boat Name-Make: ______ New boat? Y / N
Cell Phone: ______ Zip code: ______
Email: ______
q Choose Departure Day: ___ Wednesday ___ Thursday
Names of Crew: Please indicate t-shirt size / type. Crew names are very important (video, magazine, etc…)
Captain: ______1st Mate: ______
T-shirt size: S M L XL XX (circle one) T-shirt size: S M L XL XX (ladies top)
Crew 1: ______Crew 2: ______
T-shirt size: S M L XL XX (ladies top) T-shirt size: S M L XL XX (ladies top)
Crew 3: ______Crew 4: ______
T-shirt size: S M L XL XX (ladies top) T-shirt size: S M L XL XX (ladies top)
Crew 5: ______Crew 6: ______
T-shirt size: S M L XL XX (ladies top) T-shirt size: S M L XL XX (ladies top)
______
Club Membership is necessary to participate on this event. Do you need membership information? Y / N
Insurance Policy Information- Insurance Co: ______
Agent ______Agent Phone # ______
Insurance Policy Number? Please list Policy#:______
Note: If we do not have a copy of your insurance, a copy must accompany this application.
Event Fee (Captain & mate): $750…………………….. ……….…..……...….. $ 750.00
Extra crew: _____ x $175 Includes event tee, hat and function passes…….. $ ______
Additional T-shirts $20.ea –Personalized if registered by Oct 5th …………….. $ ______
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+ …….... $ ______
Additional Dinner passes: ____ x $75 ...... ………………....…..…… $ ______
Total Payable: ...………….…...... $ ______
FEES PAYABLE TO: FLORIDA POWERBOAT CLUB: 1214 SW 6th St. Pompano Beach, FL 33069
*Amex* M/C* VISA* Discover* Check CV# code: ______
Card#: ______Exp: ______
Name: ______Signature: ______Date: ______
No returns or refunds, cancellations. Credit policy applies to all prepaid event fee
PLEASE FAX A COPY OF THESE FORMS TO: Fax (954) 782-2452
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FLORIDA POWERBOAT CLUB –KEY WEST POKER RUN ‘17
Docking and Accommodations & Reservation Form
Member Name: ______Date: ______
NORTH LOCATION & SOUTH LOCATIONS AVAILABLE
Mandatory Captains Meeting in Miami the night before departure
Choose Departure Day: __Wed/Tues Capt Meeting __ Thurs /Wed Capt Meeting
***ROOMS RATES SUBJECT TO CHANGE***
South Location:
Sonesta Number of rooms: _____ Room type: ____ Deluxe Double / King Room - $300/night
Ritz Carlton Number of rooms: _____ Room type: ____ Deluxe Double / King Room - $399/night
Docking Info – Grove Harbour Marina - Y / N $3.50/ft Needs: Water / Electric Call for lift service
North Location:
Trump International Number of rooms: _____ Room type: ____ Double / King Room - $210/night
Docking Info – Haulover Marina - Y / N
Return rooms: ______
Key West Hotel
& Marina
Book by Oct 12 for these rates
Rooms needed in Key West? Y / N Number of rooms: ______
1st choice: ______2nd Choice: ______
See box above on right for choices and rates
Room requirements? ____ King Room ___ Double Room
Slip Needed: Y / N
Various Marinas on Stock Island- $3.50-$4.50 per foot ______
**All Historic Seaports in Key West are sold out**
Return to Miami: ___ Sunday ___ Monday
(Race finals on Sunday after 3pm)
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