Poker Players - Bankroll Application

First Name
Last Name
Date Birth
Address
City
State / Prov
Zip / Postal
Country
Email
Password
Password Retype
Phone
Occupation
Salary

Poker Websites

Please list your USERNAME / USER ID, for any of the following websites you play at. If you play on other sites, please use the other boxes and list both the name of the site and your username.

Full Tilt
PokerStars
Party Poker
Ultimate Bet
Absolute
Everest
Bodog
Doyle's Room
Titan
Cake Poker
Other 1
Other 2
Other 3

Casinos

Let us know which casinos you play at:

Bellagio		yesno
Caesars		yesno
Wynn		yesno
Venetian		yesno
Rio		yesno
Mirage		yesno
Commerce		yesno
Bicycle		yesno
Borgata		yesno
Foxwoods		yesno
Other 1
Other 2
Other 3

Poker Levels

Tell us about your poker play:

I Consider Myself	beginnerintermediateadvancedsemi-propro
Average Cash Game Bankroll	in USD
Average Tournament Buy-In	in USD
Average Hours Played Weekly	in whole hours
Poker Earnings in Last 12 Months	in USD

Poker Tourneys

Let us know if you play on any of the following tourneys:

WPT		yesno
WSOP		yesno
EPT		yesno

Poker Preferences

Your personal preferences for playing poker:

I Prefer Live	cash gamestournaments
Wish to Play Poker Full Time	yesno
Can Relocate for Poker	yesno
Can Play Poker 25+ Hours per week	yesno
Requested Bankroll	in USD