ASPD HIGHLAND GAMES MEMBERSHIP 2003

NAME: _______________________________________________________________________

      _______________________________________________________________________

ADDRESS: ____________________________________________________________________

         ____________________________________________________________________

         ____________________________________________________________________

POSTAL CODE: ________________________________________________________________

CONTACT: ____________________________________________________________________

POSITION: ___________________________________________________________________

PHONE: (      ) _____________________________________________________________

FAX:   (      ) _____________________________________________________________

E-MAIL: _____________________________________________________________________

WEBSITE: ____________________________________________________________________

SIGNING AUTHORITY:

_____________________________________________________________________________


FEES FOR 2003:	  $100


ALTERNATE CONTACT: (Please print)

NAME: _______________________________________________________________________

PHONE: (      ) _____________________________________________________________


NAME: _______________________________________________________________________

PHONE: (      ) _____________________________________________________________


REGISTERED NON-PROFIT: ______________________________________________________

NON-REGISTERED: _____________________________________________________________