Views and Brews Patch Request Form

Name:    ___________________
Address:___________________
               ___________________
               ___________________
               ___________________
Email:   ___________________ (optional)

Method of Payment: __________________ (Money order or Paypal)



I certify that I have completed the required number of the Hikes and Brewpubs listed by Views and Brews.

STATE _____________

____________________  on  ______________ 
Signed                                                                    Date

Favorite Hike:              _________________
Favorite Pub or Beer: _________________



Mail this form and the completed list to:

Views and Brews
c/o Tom Rankin

8 Wallkill Ave.
Tillson, NY 12486