Poker Registration Form

2026 Poker Craze Entry Form
February 21, 2026
Registration & No Host Bar 4pm
Dinner 5pm
Tournament Play 6pm

$10,000 Prize Pool
PAYOUTS IN PRE-PAID VISA GIFT CARDS. PRIZE POOL IS SUBJECT TO PARTICIPATION

EARLY BIRD SPECIAL 1,000 BONUS CHIPS IF ENTRY AND PAYMENT RECEIVED BY 02/06/26
(Note only one registration per player)

YOU ARE NOT REGISTERED TO PLAY UNTIL PAYMENT HAS BEEN RECEIVED.

Contact Information

First Name

Last Name

Email Address

Address Line 1

Address Line 2

City

State

Postal Code

Phone Number

Initial Buy-In 5,000 Chips Note Only One Registration Per Player

$100

$100

Add-On 10,000 Chips Note Only One Registration Per Player

$100
None

$100

None

Tri-Tip Dinner 5pm Player

$10
None

$10

None

Additional Tri-Tip Dinner Guest

$10
None

$10

None

PAYMENT IS DUE AT TIME OF SUBMISSION OF FORM

3% CARD FEE

3% CARD FEE

** (1) One re-buy of $200 for 15,000 chips will be offered through the 1st break**

Additional Guests for Dinner? Please note total here.

Signature

E-signature

Type in your name

Date

AFTER SUBMITTING APPLICATION, PLEASE CALL EMERY AT 541-440-4396 FOR PAYMENT.

YOU ARE NOT REGISTERED TO PLAY UNTIL PAYMENT HAS BEEN RECEIVED.

Submit