Lake Charles Symphony’s

Texas Hold’em Registration

Lake Charles Civic Center

Friday, November 30, 2007

Print and Complete this form to Register.

By purchasing this ticket, you agree to all Terms and Conditions. Tickets are $100 per person ($10 registration fee is waived for payments received before Nov. 30, 2007). Your payment is your acknowledgement of the tournament rules and regulations as posted on this website. You can pay by check or credit card via mail or FAX, telephone, or drop off at the Lake Charles Symphony office located at 809 Kirby, Rm. 210, Lake Charles, LA . Checks are payable to Lake Charles Symphony.  Your Confirmation letter will be mailed via first class mail upon receipt of payment.  Confirmation letters for Registration forms received the week before the tournament will be available at Will Call the day of the event, November 30, 2007. You must bring your Confirmation Letter as it is your entry ticket. You must present a copy of the Confirmation Letter and your driver's license to be admitted without paying again. You must be 21 years of age prior to the date of the event.

If you are purchasing a ticket for someone else, please submit the name, age, and date of birth of the player. All fields are required.

 

Player First Name:   ____________________________________________

 

Player Last Name:   ____________________________________________

 

Player Age:              ________________________

 

Player DOB:            ________________________

 

Phone Number:       ________________________

 

Email:                       ________________________

Your email address will be used for tournament communication only; it will not be sold or distributed to a third party.

 

Shipping Address:    ___________________________________________

 

City:                           ___________________________________________

 

State:                         __________________        ZIP     ________________
 

Details

Buy-Ins:     $100 for $16,000 in chips.

Re-buys:     $50 each for $8,000 in chips.

Add-Ons:   $100 for $16,000 in chips

 

  No.                            Total

Re-buys:                       _____                       _____

Add-On:                      _____                       _____

TOTAL                                                       ______        

Charge my:     O  Visa        O  Master Card        O  Discover        O  AMEX

Credit Card #________________________________________________Exp. Date_________________________________

Authorized Signature___________________________________________________________________

Complete this form and either mail (P.O. Box 3102, Lake Charles, LA 70602-3102), FAX (337-433-1615), call 337-433-1611 or drop it off at 809 Kirby St., Suite 210, Lake Charles. Make Checks payable to Lake Charles Symphony.

Note:  If a registrant is unable to attend the tournament a substitute may replace him/her.  Please notify the Symphony office at (337) 433-1611 as soon as possible before the tournament.