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Your Screen Name(Req)
(Name you want displayed
ie..Poker Nickname
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Cell Provider: (Req)

Cell Provider Other: (Req if Provider is Other)
Street Address: (Req)
Apt #:
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Email Address(Req)
We want players who actually do play. Will you occasionally sign up to play in the Clubs poker games?       Yes   No
We want responsible players. Will you show up to tournaments you sign up for? Yes Always   Not Always
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Who is Referring You?
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