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Gold Country
LionsEnterprises
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Anderson
Anderson Poker Run
10th Annual Gary
Motorcycle
Pre-Registration Form
Riders Name: ____________________ Passengers Name: ______________________
Street Address: ________________________________ Phone: _____________________
City/State/Zip: _______________________________
Email Address: ________________________________
Extra Poker hand No. ____x $15.00=__________
Gold Country Lions- Poker Run 2015
P.O. Box 531
Grass Valley, CA 95945
Please make checks payable to Gold Country Lions Club and mail with this entry form by
May 1, 2015
For more information, call (530) 265-6393 or
E-mail: goldcountrylions@sbcglobal.net