Deuces Wild Charity Poker Run Registration Form

First Name

Last Name

Email Address

Phone Number

Address

Address 2 (Apt, Suite)

City

State

Zip Code

Vehicle Description

License Plate #

Number of Riders

Vehicle Insurance Vehicle Insurance Yes No

Emergency Contact

Emergency Phone

The Legal Stuff The Legal Stuff By Checking this box I certify I have Completely read, understand and agree to the following o All vehicles entered into the Poker Run must be registered. Driver must wear Bracelet and show on wrist at all times during the event and reveal on demand to the Conservation Officer and Resort Staff. Driver must be 18 years of age or older and a licensed driver. Each vehicle must have full insurance and must be provided toevent staff. All Vehicles entered into the Poker Run MUST BE 4x4 with Four Wheels, MUST have Safety Equipment in Vehicle including Tow Cable, Harness or proper restraints, Helmets, Fire Extinguisher, Communication Radio (cellphone ok) and Water. Exercise Good Samaritan Practice of Helping those in need. Remember to lookout for Wildlife (Tortoises, Burro, Snakes, etc.) This is a LEISURE RUN and NOT A RACE. Respect the land.

By checking this box, I agree to and attest that I have read and full understand that I ASSUME ALL OF THE RISKS OF PARTICIPATING AND/OR VOLUNTEERING IN THIS ACTIVITY OR EVENT, INCLUDING RIDERS/PASSENGERS OF DRIVER, including by way of example and not limited to, any risks that may arise from negligence or carelessness on the part of the persons or entities being released and/or from dangerous or defective equipment or property owned, maintained, or controlled by them. I certify that I am physically fit, have sufficiently trained and participated in OFF-ROAD Events and have not been advised otherwise by a qualified medical person. I acknowledge that participating in this event is a potentially hazardous activity and potentially could in injury and or death. I assume all risks associated and legal accountability with competing and participating in this event. These risks include, but are not limited to, those caused by terrain, water condition, weather, lack of hydration, and actions of participants, volunteers, spectators, or producers and promoters of this Event. I release and discharge from any and all liability, damage, property theft, injury including death or actions of any participants or my traveling to this event hosted on Chemehuevi Indian Tribe Land hosted by Havasu Landing Resort Casino Hotel, all sponsors, event directors, volunteers and all municipalities in which the event is conducted. I hereby agree to indemnify and hold harmless the persons or entities mentioned in this paragraph from any activities connected with the Poker Run in which I may participate. I also give full permission for the use of my name and photographs in connection with this event. I understand that all entry fees are nonrefundable. I CERTIFY THAT I HAVE READ THIS DOCUMENT, AND FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A WAIVER, RELEASE OF LIABILITY AND AN INDEMNITY CONTRACT AND I SIGN IT OF MY OWN FREE WILL.