Friday, August 23rd, 2024

Full list of stops to come soon!

Registration includes the poker hands, breakfast coupon, and t-shirt for the Captain & First Mate

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Captain Name *

Address *

Address Line 1

Address Line 2

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Phone *

Email *

Captain Age *

Captain Gender *

Captain Shirt Size *

First Mate Name *

First Mate Age *

First Mate Gender *

First Mate Shirt Size *

Single Item *

Price: $450.00

Additional PassengersNo Additional Passengers – $0.001 Additional Passenger – $150.002 Additional Passengers – $300.003 Additional Passengers – $450.004 Additional Passengers – $600.005 Additional Passengers – $750.006 Additional Passengers – $900.007 Additional Passengers – $1,050.008 Additional Passengers – $1,200.009 Additional Passengers – $1,350.0010 Additional Passengers – $1,500.0011 Additional Passengers – $1,650.0012 Additional Passengers – $1,800.00

Additional Passengers Include breakfast coupon, poker hand, and t-shirt.

Additional Passenger Shirt Sizes

Please list male or female next to each size.

Extra HandsNo Additional Hands – $0.001st Extra Hand – $75.002 Extra Hands – $150.003 Extra Hands – $225.004 Extra Hands – $300.005 Extra Hands – $375.006 Extra Hands – $450.007 Extra Hands – $525.008 Extra Hands – $600.009 Extra Hands – $675.0010 Extra Hands – $750.00

Total *

$0.00

Stripe Credit Card *

I have read and agree to the Poly Lift Lake of the Ozarks Shootout Poker Run Rules and Policies *

Clear Signature

Rules are below

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