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.