Glenn County Sheriff's Posse, Inc.
PO Box 422, Orland, Ca.,95963
530-865-5510
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Entry Form: Poker Ride April 14th 2012
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Entry fee of $30.00 per rider is enclosed: $30.00 or $60.00 (circle one)
Name :____________________________
Address:_______________________
City:__________________________
State:_____________Zip:_________
Phone:_________________________
E-mail:________________________
Name:__________________________
Addres:_________________________
City:___________________________
State:_______________Zip:________
Phone:__________________________
E-mail:_________________________
I save and hold harmless the GLENN COUNTY SHERIFF'S POSSE, INC., its
Members, Officers, the Board of Directors from any and all damages or injuries to
myself, my equipment, my horse and vehicles under my control during my participation in
this event.
_______________________________ __________________________________
Rider # 1 Rider # 2
Mail to: Glenn County Sheriff's Posse
P.O. Box 422
Orland, Ca., 95963
Questions: 530-865-5510
530-570-3633
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