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FLORIDA POWERBOAT CLUB

WINTER POKER RUN 2017

To: Hawks Cay on Duck Key

January 27-29, 2017

Member Name: ______

Boat Name-Make: ______ New boat? Y / N

Email: ______ Zip code: ______

Cell Phone: ______Decal Color choice: ______

Names of Crew: Please indicate t-shirt sizes (see * below). Crew names are very important (video, 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 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*: Powerboats: $650 (Captain + mate- no safety fee assessed) …$ ______

Extra crew: $75 ______Includes event tee & 3 functions ……….………….………….$ ______

Additional T-shirts or Ladies tanks $20 each .……..………………………………….………$ ______

Tee Sizes: ___S ___M ___ L ___XL ___XX - Ladies tanks: ___S ___M ___L

Other Charges/credits: ………………………………………………………………………………….…... $ ______

Total Payable: ...………….…...... $ ______

*Cruisers/Yachts: $600 (2crew) Cars: $350 (Driver & guest) Motorbikes: $150 (1 rider)

*Event Fee includes (1) poker hand per team and participation in the boating, driving, riding activities which are accompanied by photo and video teams for extensive television & media coverage. Two tshirts, event DVD, decals, dockside breakfast at Grove Harbour Marina before departure, poker run lunch in the Keys, welcome reception in Marathon, Saturday fun run. FPC staff will make ALL reservations for rooms and dockage in Miami and in Marathon for all guests.

Event Fees may be paid by: Amex M/C VISA Discover Check

Card#: ______Exp: ______VIN: ______

Name: ______Signature: ______Date: ______
No returns or refunds, cancellations. Credit policy applies to all prepaid event fees

PLEASE FAX A COPY OF THESE FORMS TO:  (954) 782-2452 or email to

FLORIDA POWERBOAT CLUB – WINTER POKER RUN ‘17 Page 2 of 2

Docking and Accommodations & Reservation Form

Member Name: ______Date: ______

Departure Hotel
& Marina

Courtyard Marriott in Coconut Grove Thursday Jan 26 / Number of rooms: _____

Room type: ____ Std. Room (Double) - $209/night ____ Std. Room (King) - $209/night ____ 1BR suite $319

Special Needs: Return Rooms Y / N Marriott Rewards # : ______

Docking Info – Grove Harbour Marina - $2.50 /ft Slip: Y / N Water: Y / N Electric: Y / N
Special Needs: ______

.

Hawks cay in Marathon $39 resort fee

Guestroom $210 / night

Number of rooms: ______/______King _____ Double

Two Bedroom Villa rates:

______Marina View – near boats $299/night

______Harbor View - $269/night

Friday to Sunday departure unless otherwise noted

Docking Info - $3.60/ft private slips Slip: Y / N 30’ min -100ft maximum length 20 ft beam

Other Notes: ______

Credit Card Info - Amex M/C VISA Discover Check

Card#: ______Exp: ______Vin: ______

Name: ______Signature: ______Date: ______
No returns or refunds, cancellations. Credit policy applies to all prepaid event fee

PLEASE FAX A COPY OF THESE FORMS TO: (954) 782-2452

OR Scan and email to:

Visit our web site for more information