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FLORIDA POWERBOAT CLUB WINTER POKER RUN TO KEY LARGO 2018 January 26-28

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. 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) ______

Event fees DO NOT INCLUDE accommodations or dockage. *Note: Late fees of $100 will be added for registrations received after January 5, 2018

Event Fee: (Captain & mate): $800………………………….………………………………………...$______Extra crew: ______X $175.00 Includes event tee and functions passes….…….$______Additional T-shirts or Ladies tanks $20 each .……..………………………………….…………..$______Tee Sizes: ___S ___M ___ L ___XL ___XX - Ladies tanks: ___S ___M ___L Safety Management Fund: $50 for all boats……...... $50.00 Other Charges/credits: ………………………………………………………………………………….…... $ ______Total Payable:………………………….…………$- ______

FEES PAYABLE TO: FLORIDA POWERBOAT CLUB: 1214 SW 6th 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 [email protected]

CONTACT FLORIDA POWERBOAT CLUB FOR MORE INFORMATION: Weekdays 10AM – 5PM  (954) 545-1414 -  Fax (954) 782-2452 - www.FLPOWERBOAT.com

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DOCKING AND ACCOMMODATIONS - RESERVATION FORM

Member Name: ______Date: ______Note: A copy of your insurance declaration page must accompany this registration. _

Club Membership is necessary to participate on this event. Do you need membership information? Y / N

Please note 13% City & County Tax and 22% resort fees will be added to your DEPARTURE HOTEL & MARINA IN SUNNY ISLES rooms.

Thursday Jan 25 (Limited Rooms – Please contact FPC for these SPECIAL RATES)

Doubletree by Hilton Ocean Point Resort & Spa: Number of rooms: ______

Room type: One bedroom suites and standard studio: $299 ______King ______Double Two bedroom suites: $449 ______King ______Double

Special Needs:: ______Return Rooms: Y / N

Docking Info: Haulover Marine Center Slip: Y / N Water: Y / N Electric: Y / N

.

Please note a 12.5% Tax will be added as well as a $39 Resort Fee per room per DESTINATION HOTEL & MARINA day PLAYA LARGO RESORT & SPA Number of rooms: ______

Two story Bungalow $639 ______1 king upstairs with sleeper couch and 1 king Downstairs (can sleep 6) Single/Double Bay Front Suite $519 _____ King _____ Double Partial Bay View $439 _____ King _____ Double Resort View $ 359 _____ King _____ Double (Check Out is Sunday January 28)

Docking Info - $3.00/ft Slip: Y / N (Limited to 25 Boats in Total Registration)

CREDIT CARD INFO - Amex M/C VISA Discover Check Card#: ______Exp: ______Vin: ______No returns or refunds, cancellations.edlicy applies to all prepaid event fee PLEASE FAX FORM TO (954) 782-2452 or email [email protected]