Print this page to snail mail to Gregory.     To register online, go HERE.

10th Annual High Country Brotherhood of the Heart Gathering

October 14 – 16, 2022
 
REGISTRATION FORM
 

NAME: ________________________________________________

 

EMAIL: _______________________________________________

 

Snail MAIL ADDRESS: __________________________________

 

PHONE NUMBER: _____________________________________

 

ALLERGIES / FOOD PREFERENCE: _____________________________________________

 

MEDICAL CONSIDERATIONS: ___________________________________________________

 

 
Check one of the choices below:
Single residency? $340.00       ________

Double Occupancy?  $280.00   ________  

Roommate Name  Preference ______________________

EMERGENCY CONTACT Info 

NAME: ________________________________________

 

PHONE NUMBER: _______________________________

 

RELATIONSHIP: _________________________________

 

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Checks should be made out to: High Country Brotherhood of the Heart Please mail this form and payment of $100 deposit to: Gregory Possman 8765 NC Hwy 194 N Todd, NC 28684