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REGISTRATION FORM
Owner Name:_____________________________________ EMAIL Address:____________________________________
Owner Address:_________________________________________________________ State:_______ Zip:____________
Phone#: (_____)_____________Emergency # Contact during Event: (_____)_____________ Number of Crew:_______
Hotel Name while attending event: ________________________________Boat Registration #:____________________
__________________________________________________________________________________________________
Boat Name:________________________ Make/Model:____________________________ Length:________ Year:_____
Engine Manufacturer:___________________ Engine Size:________ # of Engines:_____ Drive Type:_____________
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SHOOT-OUT Class:
Hull Type: VEE_____ CAT_____
Engine Class: Mercury Factory Stock ______ Custom Modified______
Length: (25” to 30’)_____ (31’ to 36’)______ (37’ to 42’)______ (43’+)______
Performance Cruiser: (Up to 39’) _____ (39’ plus) _____
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Crane Launch: NO____ YES____ (Request required by 6/20/2010)
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Insurance Co:____________________________________ Policy #________________________Policy Expires: ________
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REGISTRATION FEES:
Captain and Boat + 1 Crew + 1 Poker Hand = $200
Crew: $50 per person
Extra Poker Hand: $50
INCLUDES: Friday STAMPEDE Party (Event Wristband Required)
Saturday GUNSLINGER POKER RUN & OUTLAW SHOOTOUT (Event Wristband Required)
- Gunslinger Extra Hands may be purchased by Registered Persons Only
- Additional Calcutta Poker Game available to Captains Only. (Entry by Auction on Friday evening)
TOTAL REGISTRATION FEE: CASH_____ CHECK #_______ CREDIT CARD ______ Money Order______
Entry $200 + # of Additional Crew___ x $50 + Additional Hands___ x $50 = $________
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Please remit payment with a copy of this Form to: Texas Outlaw Challenge P.O. Box 580388 Houston TX 77258
I have read, understand, and agree to abide by Texas Outlaw Challenge Terms & Conditions, and Rules & Regulations.
Signature: _______________________________ Date: __ /__ / __ Print Name:_________________________
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