Post on 21-Aug-2020
The Finals at the 2010 Casino Royale Dinner & Auction
www.casinoroyalecharity.orgphone: 818.865.8006 email: edwinvelarde@opfdbettersmiles.com
REGISTRATION FORM2010 Casino Royale
Charity Poker Tournamentwww.casinoroyalecharity.org6:00 PM, Friday, October 15, 2010First Neighborhood Community Center
31830 Village Center RoadWestlake Village CA 91361
NAME: _____________________________________________________________________________________________
EMAIL: _____________________________________________________________________________________________
ADDRESS: _____________________________________________________________________________________________
_____________________________________________________________________________________________
PHONE: _____________________________________________________________________________________________
INDICATE ALL THAT APPLY:
___ Player Entry Pre-registration fee by 09/30/2010 is $65/Player ENTER AMOUNT:___________(a)
Enter Player’s Name: ____________________________________________________
___ Dinner Only –Pre-registration fee by 09/30/2010 is $35/Guest ENTER AMOUNT:___________(b)
Enter Guest Name: _______________________________________________________
___ Also would like to be Guest/s at the 2010 Casino Royale Dinner & Auction
On November 6th, 2010 at the Ronald Reagan Presidential Library
Guest Name: ______________________________________________________________
Guest Name: ______________________________________________________________
2010 Casino Royale Dinner & Auction $125/person x __________ = ENTER AMOUNT:____________(c)
Add line (a), line (b) and line (c) and ENTER TOTAL: __________________
PAYMENT:
____CHECK (#_________) IS ENCLOSED Write check to Rotary Club of Westlake Village UCF
____PLEASE CHARGE THE TOTAL AMOUNT OF ________________ ABOVE TO:
CREDIT CARD NUMBER:_______________________________________________________________
3-DIGIT SECURITY CODE: __________ EXPIRATION DATE: __________________________
ACCOUNT HOLDER NAME:______________________________________________________________
BILLING ADDERSS: _________________________________________________________________
ACCOUNT HOLDER SIGNATURE: X_____________________________________________________
Mail this form & payment to: Rotary Club of Westlake VillageEdwin A. Velarde
Chair, 2010 Casino Royale Dinner & Auction& Charity Poker Tournament
P. O. Box 3331 Westlake Village, CA 91359
email inquiries to edwinvelarde@opfdbetteramiles.com
The Rotary Club of Westlake Village Unrestricted Charitable Foundation is a 501(C)(3) not-for-profit organization. Contributions are tax-
deductible as provided by law. Tax ID # 20-1898894. Views and opinions expressed by Rotary Club of Westlake Village are not necessarily shared
by Ronald Reagan Presidential Library and Foundation.