1000 Islands Charity Poker Run - GOLD SPONSOR Registration

Boat Captain Information

• * First Name:
• * Last Name:
• * Name of Business, Organization, or Individual for Sponsorship:
• * Email Address:
• * Confirm Email Address:
• Address 1:
• City:
• State: --Choose-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming -------------- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory
• ZIP Code:
• Province:
• * Phone:
• * Captain T-Shirt Size: --Choose-- Small Medium Large XL 2 XL 3 XL 4 XL

• Fee

  Type	Fee
  Event fee	$3,500.00

NAVIGATOR INFORMATION

• Navigator Name:
• Navigator T-Shirt Size: --Choose-- Small Medium Large XL 2 XL 3 XL 4 XL

BOAT INFORMATION

• Please send us a picture of your boat that we can use on social media and on our website to announce your attendance at this year's event!

• * Boat Make:
• * Boat Year:
• * Boat Hull Type:
• * Boat Length:
• * Boat Beam - *BE SPECIFIC PLEASE!!
• Boat Name:
• * The Top Speed of Your Boat:
• * Intended Top Speed During Poker Run / Intended Cruising Speed: (this will determine which speed group you are in during the run)

INSURANCE INFORMATION

• PROOF OF INSURANCE IS REQUIRED in order for you to participate in the run! You may submit your Proof of Insurance by: Website: http://www.1000islandsrun.com/charity/upload-proof-of-insurance/ Email: info@1000islandsrun.com Fax: (315) 686-5564 Mail: PO Box 56 - Clayton, NY 13624

• * Please note: If your insurance expires/renews before July 15, 2023 we will need an updated copy of your insurance *

ADDITIONAL CREW Information

You may add a maximum of 6