FLORIDA POWERBOAT CLUB

EMERALD COASTPOWERBOAT POKER RUN 2018

August 15 – 19, 2018

Name:______Boat Name: ______

Cell Phone: ______Email: ______Fax: ______

Non- FPC members please include address & boat information:

Address: ______City: ______ST:___Zip:______

Boat Make: ______Length: ______Vee or Cat? (Circle) Total HP: ______

Names of Crew: : Please indicate t-shirt sizes. 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 (circle one)

Crew 1: ______Crew 2: ______

T-shirt size: S M L XL XX (circle one) T-shirt size: S M L XL XX (circle one)

Crew 3: ______Crew 4: ______
T-shirt size: S M L XL XX (circle one) T-shirt size: S M L XL XX (circle one)

Crew 5: ______Crew 6: ______

T-shirt size: S M L XL XX (circle one) T-shirt size: S M L XL XX (circle one)


Event fees DO NOT INCLUDE accommodations or dockage.

Event Fee (Captain & mate):$750 ……...….……...….……...……...……...…..$750.00

Extra crew: ______x $150 Includes event tee and function passes………..$ ______

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

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

Additional Event Videos DVD ($30) ___ ……………………………..……….....$ ______

Safety Management Fund: ____ $50 for all boats …..……………………………..$ ______

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

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

FEES PAYABLE TO: FLORIDA POWERBOAT CLUB: 1214 SW 6 St. Pompano Beach, FL 33069 Event Fees may be paid by: (Please Check One)

AmexM/CVISADiscoverCheck

Card#:______Exp:______CVV: ______

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

PLEASE FAX FORM TO(954) 782-2452 or email

CONTACT FLORIDA POWERBOAT CLUB FOR MORE INFORMATION: Weekdays 10AM – 5PM
(954) 545-1414 - Fax (954) 782-2452 -

EMERALD COAST POWERBOAT POKER RUN 2018

Docking and Accommodations - Reservation Form

Name:______Date:______

Note: A copy of your insurance declaration page must accompany this registration.

Select: Arrival Date: __Tues-14__Wed-15__Thurs-16__Fri-17Departure Date:___Sun-19___Mon 20

Hotel Information

EMERALD GRANDE

2 bedroom $370_____ 2 bedroom penthouse $390_____

3 bedroom $400_____3 bedroom corner $449_____

4 bedroom corner $531_____

***3 night minimum stay for all rooms***

Above rate does not include $30 / night resort fee and $15 / night cleaning fee

Dockage Information

Overnight Dockage Required? Y / N

HarborWalk Village

Captain’s Choice / BrooksBridge in Fort Walton Beach

Legendary Marina in Destin- In water and Dry Storage – contact them directly

AJ’s in Destin – limited to 18 boats


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

Card#: ______Exp: ______

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

PLEASE FAX FORM TO(954) 782-2452 or email