ATA PAC Poker Party Texas Hold’em CANCELED ATA PAC Poker Registration First Name* Last Name* Company* Email* Address for Credit Card Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Donation* ATA Truck PAC is requesting a $100 minimum donation to participate in the tournament. Donation must be personal money, no corporate contributions allowed.By clicking the box below, I verfiy the following statements are accurate and true: I verify these statements to be true and accurate.1. This contribution is made from my own funds and will not be reimbursed by any other person or entity; 2. This contribution is not made from the treasury funds of a corporation or labor union; 3. I am a U.S. citizen or lawfully admitted permanent U.S. resident (“green card” holder).Sponsorships AvailablePlease contact me regarding sponsorship opportunities. Yes, I would like to help sponsor this event. No, I do not want to help sponsor this event. Payment InformationSelect Credit Card Type* Visa Mastercard Discover American Express Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Expiration Date Security Code Cardholder Name Total $0.00 Confirm Last 4 of the Credit Card #* HiddenTax Type HiddenTaxCAPTCHA
