Patron's Form

Make all checks payable to "Triad Highland Games, Inc." and in remarks indicate level of Patronship. Mail the completed form and your check to:

Patrons

C/O

Triad Highland Games, Inc.
Ann Jackson
307 Gregg Street
Archdale, NC 27263

Please provide the following contact information. After completing the form press the PRINT button and your order form will be printed.

First Name

Last Name

Middle Initial

Title

Organization

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Country

Work Phone

Home Phone

FAX

E-mail

URL

Patronship Level (Individual and/or Clan)

Loch Ness ($110)

Loch Lomond ($75)

Loch Tay ($60)

Date: Signature:

BACK

First Name
Last Name
Middle Initial
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
FAX
E-mail
URL
Patronship Level (Individual and/or Clan)
Loch Ness ($110)
Loch Lomond ($75)
Loch Tay ($60)

Date:	Signature: