2014 CASINO NIGHT REGISTRATION FORM


Please fill in all appropriate information and we will contact you to complete the transaction.


Name: 

Address: 

City:  State:   Zip: 

Work Phone: 

Home Phone: 

Email: 

PACKAGE TYPE:

QUANTITY:

$2,500 HIGH ROLLER PACKAGE

 $1,500 ROYAL FLUSH PACKAGE

 $1,000 ALL IN PACKAGE

 $500 BLACK JACK PACKAGE

 $50 JACKPOT PACKAGE



Payment Information:
We will contact you for payment

For More Information, please contact Jimmy Frush at 361-825-3237 OR james.frush@tamucc.edu

***YOUR RSVP IS REQUESTED BY FRIDAY, AUGUST 1***