2024 Gypsy Tour Poker Run Registration Form

2024 Gypsy Tour Poker Run Registration Form

August 10, 2024 | Downtown Springfield, Missouri
Driver's Name (including 1 hand)*

First NameLast Name
Driver t-shirt size (choose 1)*

SmallMediumLargeXL2XL
Passenger's Name (including 1 hand)

First NameLast Name
Passenger t-shirt size (choose 1)*

SmallMediumLargeXL2XL
Will you have extra hands? How many? ($5 each)
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Payment

$25 per driver | $5 per passenger | $5 per extra hand

Please select your options below and use the secure payment field below to submit your payment.

Driver

$25.00 Quantity

Passenger

$5.00 Quantity

Extra Hand

$5.00 Quantity

Total

$0.00

Terms and Conditions

In consideration of the right to participate in the Poker Run, participants release and discharge the Birthplace of Route 66 Festival, Ozarks on Two Wheels, and anyone connected with the management and presentation of this event from any and all known damages, injuries, losses and/or claims for any cause that may be suffered by the entrant and his/her property.
Signature*

Clear
On a computer, use your mouse to sign your name. On a tablet or phone, use your finger to sign.
You may also download the PDF form here. Mail the completed form with a check made payable to Route 66, 3271 E. Battlefield, Suite 350, Springfield, MO 65804
Should be Empty:

Payment