Member Information

   
   

First Name: (Req)

Middle Initial:

Last Name: (Req)
   
Your Screen Name(Req)
(Name you want displayed
ie..Poker Nickname
   
Status:
   
Birth Date (Req)

   
   
Cell Number: (Req)

Cell Provider: (Req)

Cell Provider Other: (Req if Provider is Other)
   
   
Street Address: (Req)
Apt #:
City: (Req)
State: (Req)

Zipcode: (Req)

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
   
How Did You Hear About US?
Who is Referring You?
(Req)
   
   
Login Information
Username:(Req)
Password (6+ char)
(Req)
Confirm Password:
(Req)
   

 

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