Ride Registration

Mission Statement:
A foundation that supports those suffering from cancer in our community.
Helping provide support in an emotional, physical, spiritual, and financial
manner.

Selma's Cancer Support

2011
POKER RUN

For more information call us at
559-891-7591

Registration Form

$35.00 Per Person

Registration includes t-shirt, drawing ticket, breakfast, and lunch.

First Name

Last Name

Address

City

State

Zip Code

Phone Number

Cell Phone

Email Address

2XL add $1.00
3XL add $2.00

Shirt Size

Payment Method

All Payments must be received by
May 14th to receive an event t-shirt.

By clicking the submit button below, I acknowledge that I have read the ride waiver
and release form and I agree to the rules and regulations.
Click here to read form