ATLARGE 2010 Registration

First Name

Last Name

Street address

City

State

ZIP

E-mail

Nickname on badge (large print)

Real name on badge (small print)

I intend to play in:

TOC ($100 + 20) Play

NLHE ($100 + 20) Play

Stud/8 ($100 + 20) Play

I intend to attend:

Smoker Yes

Banquet Yes

Sample badge:

Paid (admin use only)