Poker Run Pre-Registration
Deadline April 1, 2010
Please Print and Mail this Registration to:
BKMC, P.O. BOX 482, PRINCETON, LA 71067
Rider Number 1 Rider Number 2
Name ________________________________________ Name: _________________________________________
Address: ______________________________________ Address: _______________________________________
City: ______________________ St____ Zip __________ City: ______________________ St____ Zip ___________
Phone: ________________________________________ Phone: ________________________________________
Email: ________________________________________ Email: _________________________________________
T-shirt Size (circle one) S M L XL XXL T-shirt Size (circle one) S M L XL XXL
_________ # Registrations @ $25.00 each = $ _______________
_________ Check or Money Order Enclosed (made payable to BKMC)
2010 Pre-Registration for the BKMC Burn Run. This registration allows the above riders to participate in the Poker Run.
Liability Release: By purchasing this registration, you and your party will not hold Brothers Keepers Motorcycle Club, Lake Bistineau State Park, any organizer, contributor or property owner associated with this event responsible for loss of yourself or property by participating in this event.