MAKING A DIFFERENCE
                   POKER RUN          
SATURDAY, JULY 10, 2004    

DRIVER:
PASSENGER:
CLUB AFFILIATION:
STREET:
CITY:                                                     STATE:                                              ZIP:
PHONE NUMBER:                                                                                  EMAIL:
REGISTRATION FEE:                                                                                          #          @ $30.00 PER CAR | $
INCLUDED T-SHIRT   (circle size)        M     L     XL     XXL                                                                          |-$ 0.00-
ADDITIONAL T-SHIRTS (circle size)  M     L     XL     XXL                        #          @ $15.00 EACH       |  $
OPTIONAL BOX LUNCH   (from Quiznos)                                                       #          @ $10.00 EACH       | $        
____The Traditional (roast beef, turkey, ham, cheddar, lettuce, tomato, red onion, black olives, ranch dressing)
____Mesquite Chicken with Bacon (chicken, bacon, cheddar, lettuce, tomato, red onion, ranch dressing)
____Philly Cheese steak (grilled steak, white cheddar cheese sauce, sautéed onions, & spices on a Philly roll
OPTIONAL SATURDAY NIGHT BANQUET                                                  #          @ $17.00 EACH       | $
Order at restaurant from a special menu                                                                                                                   |
YOUR CHECK # __________PAYABLE TO: SOCALM                                                                 TOTAL |

 

REFUND POLICY: Cancellation received on or before 6/25/04:  $10.00 cancellation fee
NO REFUNDS AFTER 6/25/04
NOTE: THE $30.00 REGISTRATION FEE INCLUDES:
            - PARTICIPATION IN THE POKER RUN
            - T-SHIRT (1)
            - GOODIE BAG
SEND REGISTRATION FORM AND CHECK TO:
SOCALM
1571 Rancho Hills Drive
Chino Hills, CA 91709-6238
(909) 597-1664

 

SOCALM USE ONLY:    REC'D ___/___/04     REG#______    CHECK #_______     AMOUNT  $_____