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World Series of Poker

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Date:

The World Series of Poker
2005 World Series of Poker Tournament
Pre-Registration Information and Deposit

Last Name  
First Name  
Initial  
Date of Birth  
Street Address  
City  
State  
Zip Code  
Country  
E-Mail Address  
Phone number  
Event Date  
Event #  
Event Description  
Total Buy - In Amount  

Form of Deposit
Please check one
Cashiers Check
Wire Transfer

This pre-registration form must be sent with your check or wire transfer deposit to:

Rio Suite Hotel and Casino
World Series of Poker
Attention: Accounting Office
P O Box 14160
Las Vegas, Nevada 89114-4160
Or Fax to: 702-777-7957

I understand that my ability to participate in the Tournament is conditioned upon my compliance with the Tournament General Rules and that one must appear in person to finalize the registration process . By signing this statement, I further understand that, once submitted, my deposit is non-refundable, except and unless determined so by Harrah's acting in its sole and absolute discretion.

Signature:



Bank Wire details WSOP Information Page

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