NOTICE: You will need the email addresses of your passengers, a credit card as well as your proof of insurance for your boat in order to complete this form. 2024 Unleashed Poker Run Entry FormPlease use this form to register, pay and sign all waivers prior to the Poker Run. Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. – Step 1 of 2Boater Name *FirstLastLayoutContact Phone *Contact Email *Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeMandatory Passenger Name *FirstLastMandatory Passenger Email *Please list email as an additional registration link will be automatically sent to the passenger email address listed here. Number of Additional Passengers *If more than 3 please email us at info@unleashedpokerrun.com. Add additional passengers other than the mandatory 2 passengers. DO NOT ENTER A MINUS.Will you be paying for additional passengers?Yes I will be paying $175 for each additonal passengerNo they will be paying for themselvesAdditional passengers are those passengers in addition to your Mandatory Passenger. If yes, we will add the $175 per passenger fee to the total below. If no, we will email the passengers with a link so that they can complete payment.1st Additional Passenger *FirstLast1st Additional Passenger Email *2nd Additional Passenger *FirstLast2nd Additional Passenger Email *3rd Additional Passenger *FirstLast3rd Additional Passenger Email *4th Additional Passenger *FirstLast4th Additional Passenger Email *5th Additional Passenger *FirstLast5th Additional Passenger Email *6th Additional Passenger *FirstLast6th Additional Passenger Email *7th Additional Passenger *FirstLast7th Additional Passenger Email *8th Additional Passenger *FirstLast8th Additional Passenger Email *Boat InformationLayoutBoat Manufacturer *Boat Model *Boat Length *Copy of Boat Insurance * Click or drag a file to this area to upload. If you click the above area you can search for the file rather than drag and drop.Emergency Contact InformationEmergency Contact Name *FirstLastLayoutEmergency Phone *Emergency EmailConsents & WaiversPhoto and Video Consent *I ATTEST I HAVE READ THIS ENTIRE CONSENT FORMVIDEO & PHOTO RELEASE FORM I, hereby grant permission to Unleashed Poker Run and its affiliates to use my image and likeness in any and all forms of media, including but not limited to photographs, videos, and audio recordings, captured during the 2024 Unleashed Poker Run event. I understand and agree that these materials may be used for promotional, advertising, and other related purposes without any compensation to me. I hereby waive any right to inspect or approve the finished products or the advertising copy that may be used in connection therewith or the use to which it may be applied. I release Unleashed Poker Run and its affiliates, as well as their respective officers, directors, employees, agents, and representatives from any and all claims, demands, and liabilities whatsoever in connection with the use of my image and likeness, including but not limited to any claims for defamation, invasion of privacy, or infringement of moral rights. I acknowledge that I have fully read and understand this release form and that I am of legal age and have the right to enter into this agreement. Release of Liability *I ATTEST I HAVE READ THIS ENTIRE CONSENT FORMRELEASE OF LIABILITY In consideration of being allowed to participate in the 2024 Unleashed Poker Run, I, acknowledge and agree to the following: 1. Assumption of Risk: I understand that participating in the Unleashed Poker Run involves inherent risks, including but not limited to risks associated with boating, navigation, and being in proximity to other vessels. I voluntarily assume all risks associated with my participation in the event. 2. Compliance with Laws: I agree to abide by all boating laws and regulations of the state of California, including but not limited to speed limits, navigational rules, and safety equipment requirements. I also agree to comply with all laws regarding the consumption of alcohol, including age restrictions and operating under the influence laws. 3. Release of Liability: I hereby release, waive, discharge, and covenant not to sue Unleashed Poker Run, its organizers, sponsors, affiliates, officers, directors, employees, agents, and representatives from any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by me or to any property belonging to me, whether caused by the negligence of the released parties or otherwise, while participating in the Unleashed Poker Run. 4. Indemnification: I agree to indemnify and hold harmless Unleashed Poker Run, its organizers, sponsors, affiliates, officers, directors, employees, agents, and representatives from any and all liabilities, damages, costs, and expenses, including reasonable attorneys’ fees, arising out of or related to my participation in the event. 5. Medical Treatment: In the event of any injury or illness that I may suffer during the Unleashed Poker Run, I authorize the event organizers to obtain medical treatment for me as they deem necessary, including but not limited to transportation to a medical facility. 6. Acknowledgment: I acknowledge that I have carefully read this release of liability form and fully understand its contents. I am aware that by signing this form, I am waiving certain legal rights, including the right to sue. I sign this document voluntarily and of my own free will. Participant's Signature * Clear Signature Date This Waiver Was Made: *Entry FeesTotal PricePrice: $0.00NextUpdating preview…This is a preview of your submission. It has not been submitted yet! Please take a moment to verify your information. You can also go back to make changes.PayPal Commerce *PayPal CheckoutCredit CardCard NumberExpiration DateSecurity CodeCard Holder NamePreviousSubmit Entry