2016 LakeRacer LLC Desert Storm Event Registration Forms. POKER RUN EVENT TERMS AND CONDITIONS
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1 POKER RUN EVENT TERMS AND CONDITIONS The registration fees: Each entry includes Two poker hands, two t-shirts, two adult entries for the registration party, awards banquet, prize drawings, and an aerial boat photo on a poker run photo CD. Early Registration - on or before February 1, $ Late Registration - ANY Received between February 1, 2016 and April 15, $ At Event Registration - ANY Received after April 15, $ No Registration Refunds given after April 15, Shootout add on for Poker Run participant is an additional $ Street party display for poker run participants is now an additional $100 due to increased cost of event. Additional Poker Hands are $50.00, a limit of extra six hands per boat. All Poker hands go directly to the jackpot. Additional adult entries with T-shirt are $75.00, including Thursday Registration at the Street Party; Friday Card Turn in Party, Saturday Awards Party, and Prize Drawings. Children wristbands are $15.00 for Children 6 thru 12. Children under 5 are free. Additional Poker Run T-shirts or Tanks will be available for $25.00 each. Any tied high hands will be decided by high card cut of a deck at dinner, there will be four high hand winners. Cash prize's determined by total hands sold with first twenty-five percent to a Charity to be decided. First Place - Thirty percent, Second Place - Twenty percent, Third place - Fifteen percent, Fourth Place - Ten percent Card Turn in: Friday - 6:30 to 9:30 PM at Power in the Park Poker Run Tent. Nautical Inn has set aside a limited number of rooms for our event; a special rate (2-night min.) has been arranged. You must be registered for the event to reserve a room! Max 3 rooms per registration, Reserve your room early as they are usually sold out by end of January! ( ) Check for Hotel Listing. There is a 200 boat maximum number of entries. No additional entries are planned at the event. Each participating boat must provide a copy of their current hull / liability policy and current boat registration. Each boat must supply vessel top speed and event intended speed. Depending on intended speed, the following restrictions apply. a) 0-70 mph - all persons 18 years of age and younger be accompanied by a parent or legal guardian while boat is being operated. b) 70 mph to 110 mph - all persons limited to 18 years of age and older. c) 110 mph or faster are not allowed to have back seat passengers. Each driver and all boat riders must sign the Desert Storm 2016 waiver and release. Each boat owner must provide proof of boat ownership (State or Coast Guard registration Documents) and proof of Liability Insurance. Personal Floatation Devices (PFD s / LifeJackets) are mandatory and are to be worn during this event while operating your boat. All occupants of the boat must wear PFD s. The Poker Run is NOT a race. There will be many boats on the lake not part of the run, please respect them. All boats must follow BEHIND the pace boat until released, or disqualification will result. The morning will be divided into ten groups, please stay with your assigned group. Each card station shall be considered a NO WAKE area, please approach from the stern at WAKELESS speed. Each station will be open the posted times only No refunds will be given; this would not be fair to the other participants. In case of unacceptable weather on Friday, the poker run will be held on Sunday. Photos are the exclusive property of LakeRacer, L.L.C. DO NOT OPEN POKER CARD ENVELOPES! DISQUALIFICATION WILL RESULT! I have read and agreed to the Poker Run "Terms & Conditions" (Owners Printed Name and address) (Owners Signature) Date
2 Poker Run Registration Information: Owner Name: Owner Address: City: State: Zip: Lodging Location? Add: Telephone #: Cell Phone #: Company Name: Fax #: Number in Party Boat Information: Captains Name: Throttleman or First Mate: Boat Make: Boat Model: Year: Length CG Documented?: : Boat Name: Boat Reg. No. (State or Coast Engine/Outdrive Description: Guard) Vessel Top Intended Poker Run Top Speed: # of Persons onboard: Speed: Each Must Sign Liability Waiver Insurance Co.: Policy No.: Policy Expiration Date: No Registration Refunds given after April 15, 2016 Early Registration -(before 2/1/16) (2 Adults Two Poker Hands): $ Late Registration -(after 2/1/16) (2 Adults Two Poker Hands): $ After 4/15/16-At Event Registration (2 Adults Two Poker Hands): $ Street Party Display: Boat only Truck and Boat? Length $ Extra Poker Hands (6 max): $50.00 each Additional crew member (Adult entry and T-shirt): $75.00 each. 1: Name: Shirt Size Tee / Tank / Women 2: Name: Shirt Size Tee / Tank / Women 3: Name: Shirt Size Tee / Tank / Women 4: Name: Shirt Size Tee / Tank / Women 5: Name: Shirt Size Tee / Tank / Women 6: Name: Shirt Size Tee / Tank / Women Poker Run Participant Shootout Entry (Radar Run): $ per boat. Entry fee for Poker Run Participant for two passes on Saturday.. Extra Men s Tee or Tank- shirts: $25.00 each 2XL & 3XL ea Select Shirt Sizes 1: Tee / Tank 2: Tee / Tank Select Shirt Sizes 3: Tee / Tank 4: Tee / Tank Extra Woman s - shirts: $25.00 each Select Shirt Sizes 1: 2: Select Shirt Sizes 3: 4: Children Wrist Bands: $15.00 each Wednesday: Krusin 4 Kids Participation: Boat Rides? Dock side help? Donation Amount? Total: Please remit your check or money order for the amount payable to: LakeRacer L.L.C. - Poker Run - P.O. Box Phoenix, AZ Fax: (928) (Please include a copy of your Boat Registration and Insurance Policy)
3 SHOOTOUT ONLY EVENT TERMS AND CONDITIONS The registration fees: Each entry includes, two t-shirts, two wristband for access to all event activities except poker run including awards banquet and prize drawings Early Registration - on or before February 1, $ Late Registration - ANY Received between February 1, 2016 and April 15, At Event Registration - ANY Received after April 15, $ No Registration Refunds given after April 15, Street party display for poker run participants is now an additional $100 due to increased cost of event. Additional Adult Registrations including T-shirt $ Children wristbands are $15.00 for Children 6 thru 12. Children under 5 are free. Additional event T-shirts or Tanks will be available for $25.00 each. Boats will be classed by hull type, size, number of and type engines and stock or modified engines. Trophies and possible cash prizes will include but not be limited to: First Place Overall - First Place Cat Hulls - First Place V Hulls First Place by other classes. Nautical Inn has set aside a limited number of rooms for our event; a special rate (2-night min.) has been arranged. You must be registered for the event to reserve a room! Reserve your room early as they are usually sold out by end of January! ( ) Other accommodations are available on the Island, Hotel and Recreational Vehicle. Check for Hotel Listing. Each participating boat must provide a copy of their current hull / liability policy and current boat registration. Boat owner/insurance liability will be primary over event insurance in case of bodily or property damage. If owners insurance does not cover loss, owner will be liable. Each boat must supply vessel top speed and event intended speed. Depending on intended speed, the following restrictions apply. a) Maximum of two people in each boat. All persons limited to 18 years of age and older. Each must be wearing appropriate life jackets. b) 100 mph or faster Maximum of two people in each boat. Each must be wearing appropriate safety gear, life jackets and helmets c) VHF Radio is required. Each driver and all boat riders must sign a waiver and release. This release states, "In consideration of being permitted to participate in this event, the participant will not hold LakeRacer, L.L.C. liable should they be harmed during the event". In addition that they have not taken any illegal substances nor consumed alcohol 8 (eight) hours before an event and will not consume either while operating the boat. Subject to disqualification! Each waiver must list Name, age, and sex of the driver, throttle person, and each passenger. No refunds will be given; this would not be fair to the other participants. In case of unacceptable weather on Saturday, the Shootout will be held on Sunday. Photos are the exclusive property of LakeRacer, L.L.C. I have read and agreed to the Desert Storm Shootout "Terms & Conditions" (Owners Printed Name and address) (Owners Signature) Date
4 Owner Name: Shoot Out Only - Registration Information: Owner Address: City: State: Zip: Lodging Location? Add: Telephone #: Cell Phone #: Company Name: Fax #: Number in Party: Boat Make: Boat Model: Year: Length: CG Documented?: Boat Name: Boat State Reg. No.: Engine Description: Vessel Top Speed: Driver Name: Throttle Man Name: Insurance Co.: Policy No.: Policy Expiration Date: No Registration Refunds given after April 15, 2016 Before 2/1/16 - Late Shootout Entry (Radar Run): $ per boat. After 2/1/16 - Late Shootout Entry (Radar Run): $ per boat. After 4/15/16-At Event Shootout Entry (Radar Run): $ per boat. Street Party Display: Boat only Truck and Boat? Length $ Additional crew member (Adult entry and T-shirt): $75.00 each. 1: Name: Shirt Size Tee / Tank / Women 2: Name: Shirt Size Tee / Tank / Women 3: Name: Shirt Size Tee / Tank / Women 4: Name: Shirt Size Tee / Tank / Women 5: Name: Shirt Size Tee / Tank / Women 6: Name: Shirt Size Tee / Tank / Women Extra Men s Tee or Tank or Women s Tee Shirt- shirts: $25.00 each Select Shirt Sizes 1: Tee / Tank 2: Tee / Tank Select Shirt Sizes 3: Tee / Tank 4: Tee / Tank Children Wrist Bands: $15.00 each Wednesday: Krusin 4 Kids Participation: Boat Rides? Dock side help? Donation Amount? Total: Please remit your check or money order for the amount payable to: LakeRacer L.L.C. - Poker Run P.O. Box Phoenix, AZ Fax: (928) (Please include a copy of your Boat Registration and Insurance Policy)
5 IN CONSIDERATION of being permitted to participate in LakeRacer, L.L.C. s Desert Storm 2016 Poker Run and Shootout (The Event), The Undersigned agrees: 1. To completely and fully assume the risk of property damage, series injury, and death. Organized boating activities carry significant risk that boats will be damaged by collision, docking, submerged items, and shallow water. Organized boating activities carry significant risks that participants and their passengers, crew, associates, and guests may become seriously injured, or even killed, by a boating collision or other type of accident. These risks are increased by the inclusion of large boats with high horsepower engines. The undersigned is aware of these significant risks and assumes these risks as part of the undersigned s desire to participate in this event. 2. That The Event herein is defined as including but not limited to and all activities on the Nautical Inn properties, Lake Havasu Event area s, concessions, and other appurtenant areas where any activity related to the Event, or to officiate, observe, work for, or any purpose participate in The Event. The Undersigned, for himself and personal representatives assigns, heirs, and next of kin, agrees, and on the direct representation that the Undersigned has, or will immediately inspect such areas, and upon such inspection declares, by then entering such areas, an acknowledgement that the inspected areas are safe and reasonably suited for the purposes of The Event for which this Waiver, Release, and Assumption of Risk applies and further agrees and warrants that if, at any time the Undersigned is in or about the Event areas and feels anything to be unsafe, the Undersigned will immediately advise the OFFICIALS of such and will leave such areas. 3. That The Undersigned HEREBY RELEASES, WAIVES, DISCHARGES, AND CONVENANTS NOT TO SUE LakeRacer, L.L.C., or DSM Events, their officers, officials, drivers, volunteers, promoters, advertisers, owners, and lessees of PREMISES used to conduct the event, agencies of government which control essential land and water sites, financiers and firms which render essential service gratis, and each of them, their officers and employees, all for purposes herein referred to as RELEASEES, from all liability to the Undersigned, and the Undersigned s personal representatives, assigns, heirs, and next of kin for all loss of damage, and any claim or demands therefore, on account of injury to the person or property or resulting in death of the Undersigned, whether caused by the negligence of RELEASEES or otherwise while the Undersigned is in or upon the EVENT AREAS, and or officiating in, observing, working for, or for any purpose participating in the Event. 4. That The Undersigned HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the RELEASEES from any loss, to person, vehicle or machine, liability, damage, or cost they may incur due to the presence of the Undersigned in or upon the Event Areas, or in any way or officiating in, observing, working for, or for any purpose participating in the Event, and whether caused by the negligence of RELEASEES or otherwise: and HEREBY ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH, OR PROPERTY DAMAGE due to negligence of RELEASEES or otherwise while in or upon the Event Areas, and/or officiating in, observing, working for, or for any purpose participating in the Event. This assumption of risk of negligent RELEASEES is separate and additional to the assumption of risk and property damage inherent in organized boating activities. Boat owner/insurance liability is the primary over event insurance in case of bodily or property damage. If owners insurance does not cover loss, owner will be liable. The Event offers no supplemental insurance of any kind. 5. That The Undersigned is the legal agent and has power of attorney and/or is THE PARENTS AND/OR GUARDIAN OF MINOR CHILDREN participating in the event and/or engaged in activities around, during or near the event agrees to indemnify and save and hold harmless, the releases and each of them from any loss, liability, damage, cost and attorneys fees they may incur due to the presence of the parent and/or guardian or the minor in any part of the event. While participating in the event and where to caused by negligence of the releases or otherwise. The parent and/or guardian further recognize and agree they are executing this Waiver, Assumption of Risk, and Release of Liability and Indemnity Agreement on behalf of themselves and on behalf of the minor. 6. That the Undersigned will not have taken any illegal substances nor consumed alcohol 8 (eight) hours before an on the water activity and will not consume either while operating a boat and will not allow any passenger or guest on the boat to under the influence of any illegal substances or legal substances, including but not limited to alcohol or medical marijuana, that could impair the judgment and/or interfere with the safe operation or occupation of a boat. 7. The Undersigned acknowledges that numerous docks, and docking extensions used in The Event are temporary and are not engineered. They exist for the benefit of temporarily accommodating larger boats in docks designed for much smaller boats. The stability of these docks may be less than an engineered dock and The Undersigned shall make the most minimal use of these docks and assumes the risk that any of them could increase the likelihood of injury and property damage. 8. That the weather in Lake Havasu City is erratic and unpredictable. The changing weather conditions can increase the likelihood of property damage and personal injury. The docks may be more unstable during some weather conditions and changes and The Undersigned assume the risk of any loss, whether property or bodily, for any participation in the event, including usage of the temporary docks, during any type of weather. 9. That EACH OF THE UNDERSIGNED expressly acknowledges and agrees that the activities of the Event are possibly dangerous and involve the risk of serious injury and/or death and/or property damage. EACH OF THE UNDERSIGNED further expressly agrees that this Waiver and Release of Liability and Indemnity Agreement extends to all acts of negligence by the RELEASEES, INCLUDING NEGLIGENT RESCUE OPERATIONS, and is intended to be as broad and inclusive as permitted by the law of the state in which the Event is conducted, and that if any portion thereof is held invalid, it is agreed that the balance notwithstanding, shall continue in full legal force and effect. THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS THIS WAIVER AND RELEASE OF LIABILITY AND INDEMNITY AGREEMENT, and further agrees that no oral representation, statements, or inducements apart from the foregoing written agreement have been made. Each Person riding in the boat must read and sign form, Minors must be signed for by parent. PARTICIPANT S SIGNATURE PRINTED NAME STATUS: Age: Sex: (I HAVE READ THIS RELEASE) (Circle One per) Driver Throttle Person Witness Signature: Printed Name: Date:
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