Peanut Proud Poker Run 2025! Saturday, March 1 Registration Rider Registration & T-Shirt Order Form Name* First NameLast Name Will you have a 2nd rider?* NoYes Name of 2nd Rider* First NameLast Name Address* Street Address Street Address Line 2 CityPlease SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingState Zip Code Phone Number* Please enter a valid phone number. Email example@example.com Your entry comes with 1 poker hand. If you would like to add additional hands, select how many below: Your entry comes with 1 poker hand for you and 1 for your 2nd rider. If you would like to add additional hands, select how many below: Rider's additional hands: 2nd Rider's additional hands: Would you like to purchase a T-shirt? YesMaybe later What size T-shirts would you like to purchase?* SMLXLXXLXXXL How many SMALL shirts?* How many MEDIUM shirts?* How many LARGE shirts?* How many XL shirts?* How many XXL shirts?* How many XXXL shirts?* Would you like to pay online today, or in person?* OnlineIn-Person *Persons must be 18 years old to participate* I understand and acknowledge that involvement in the PEANUT PROUD POKER RUN involves calculated risks to life and limb. However, I accept the risks of this activity and I hereby release, and will indemnify and hold FRIENDS OF PEANUT PROUD, INC. and event organizers, their officers, staff, volunteers, promoters, sponsors, participants, agents, representatives and all other persons harmless from and against all claims, demands, liability, loss, damages, costs and expenses(including attorney fees) and all other liability of every type and character, including but not limited to claims for injuries to property or persons(including crippling or disfiguring injury or death), arising from, or incurred as a result of my participation in the PEANUT PROUD POKER RUN, and I fully assume and accept all associated risks. 1st Rider Signature Clear 2nd Rider Signature Clear Your Total Amount to be paid with Paypal or Credit Card: prevnext( X ) USD Submit Should be Empty:
