Women in Poker Hall of Fame Pay by Check Ticket Form

Friday, Sept 2nd, 2011 Celebration Dinner & Ceremony

Please fill out a form for each individual who would like to attend. 

[      ] YES!

I would like to attend the ceremony and dinner. $75 per ticket
First Name:  
Last name:  
Position Title (If Applicable):  
Casino (If Applicable):  
Address:  
City, State, Zip:  
Telephone Number:  
Fax Number:  
E-mail Address:  
2nd Person First Name (If any):  
2nd Person Last name:  
2nd Person Position Title (If Applicable):  
2nd Person Casino (If Applicable):  
2nd Person Address:  
2nd Person City, State, Zip:  
2nd Person Telephone Number:  
2nd Person Fax Number:  
2nd Person E-mail Address:  
   
How did you hear about the Women in Poker Hall of Fame?:  

Make Check Payable to: Ladies International Poker Series

Send Payment to:

Ladies International Poker Series
79 Laying Up Ct
Las Vegas, NV 89148
 

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www.womenspokerhalloffame.com