Gold Medal Piobaireachd Entry Form

First Name

Last Name

Name of the Person Paying as it appears on the Credit Card, PayPal, or Check

E-mail Address

Would you like to be kept up to date on MHAF events and information via e-mail? Yes No

Street Address 1

Street Address 2

City

Country

Other Country/District

State

Province

Zip/Postal

Phone (Day)

Phone (Evening)

Phone (Int'l)

PipeBand Name

PipeBand Assn

Enter Your Grade

CPA#

(Not Required)

The Daughter's Lament ( PS 6, K)

Farewell to the Laird of Islay (PS 9)

The Black Wedder's White Tail ( PS 11)

My Dearest on Earth give me your Kiss (PS 11)

Macintosh of Borlum's Salute (PS 12)

Lament for King George III (PS 14)

The Gunns' Salute (PS 15)

Lament for Captain Donald MacKenzie (PS 15)

Purchase Winter Storm 2012: The Pipes and Drums Concert tickets

0 1 2 3 4 5 6 $35/Each

Are you coming to the FREE Winter "Steam" after-concert party?
Yes

Purchase 2012 Winter Steam Collectable Pint Glass

0 1 2 3 4 5 6 $20/Each

If you wish to pay online via Credit/Debit Card or PayPal Account, click "Pay On-Line." Otherwise, if you prefer to print your registration and mail it along with a check, click "Printable Form - PRINT and MAIL WITH CHECK." Please be patient and only click once!