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Name: ________________________ Viking Name: _______________________ Affiliations:
_______________________
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Address Street: __________________ City:___________________ State: _________________
Zip: ____________
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E Mail: _____________________ URL: ___________________________ Phone #_____________(optional)
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Join as: (circle one)
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Þræll: Just hang around. We will play with anyone who
wants to play with us. |
Bðndis: For those who just gotta get that super neat pin. For $7 in Dane geld you get the Hoard Pin. |
Jarl: For those who want all the cool stuff. For $20 in Dane geld you get: A Numbered Hoard Pin A Membership Certificate suitable for framing. An ID Card good for 10% off at Lost Viking |
If
Paying by Check, make it out to Lost Vikings Hoard and send to the
address below.
If
paying by credit card (Master Card and Visa ONLY) Fill out the info
below:
Card
VISA/ MASTER CARD (circle one)
#
on Card _________________
Name exactly as it is printed on card
_____________________
Exp. Date _____________
Send
this form to:
Lost
Vikings Hoard
79
Scioto St.
Ashville
Oh. 43103
Or Fax to 740-983-9390