Clan MacLeod Society, USA
- Great Lakes Region -
Indiana, Illinois, Michigan and Ohio
2004 North American Gathering Registration Form
(Still Under Development)
(Please print out form and print or type all information)
Name (Mr. Mrs.) __________________________________________________________________________________
Address __________________________________________________________________________________________
Home Phone ________________________________ FAX No _____________________________
E- mail _____________________________________
(Please list all members of your party being registered, including yourself. Indicate the name you prefer on your name badge. Please show age of all persons under 19.)
|
Name |
State |
Age |
|
| Badge # 1 | |||
| Badge # 2 | |||
| Badge # 3 | |||
| Badge # 4 | |||
| Badge # 5 | |||
Registration Fees: Includes Classes/Workshops, Ceilidh, Hospitality Suite and BB-Q
|
Category |
Fee |
Fee |
# Registered |
TOTAL |
|
| Adult (19 & over) |
|
= |
|||
| Youth (13-18) |
= |
||||
| Children (6-12) |
= |
||||
| Under 6 |
No charge |
No charge |
= |
||
|
TOTAL |
50th Anniversary Dinner: Includes Dinner and Transpiration, per person
|
TOTAL Dinner |
or
Medieval Times Dinner & Tournament: Includes Dinner and
Transpiration, per person
|
TOTAL Dinner |
Banquet: per person
|
|
||
|
TOTAL Banquet |
|
TOTAL Banquet: |
__________________________ |
|
TOTAL Meals: |
__________________________ |
|
TOTAL Registration Fee: |
__________________________ |
|
TOTAL Enclosed: |
__________________________ |
(Make Checks Payable to: Clan MacLeod Society USA: Mail Reservations To:)
Richard MacLeod
990 Waverly Rd.
Glen Ellyn, Illinois 60137