Women in Poker Hall of Fame Ticket Form

Friday, Sept 3, 2010 Celebration Dinner & Ceremony

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

[      ] YES!

I would like to attend the ceremony and dinner. $75
First Name:  
Last name:  
Position Title (If Applicable):  
Casino (If Applicable):  
Address:  
City, State, Zip:  
Telephone Number:  
Fax Number:  
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
 

Return to WiPHOF home page.
www.womenspokerhalloffame.com