Peronal Details

Title and Full Name:

Full Address:

Telephone Number:

Email Address:

Type of Ambassador
Copper AmbassadorGold AmbassadorRí Ambassador

Preferred Cask Wood Selection (Gold Ambassadors only)
First Fill BourbonWineFortified Wine

Payment
Electronic Funds TransferAlternative payment option

On receipt of application, we will contact you directly to arrange transfer of funds.

By ticking this box and applying to purchase this/these cask(s), I confirm that I have read and agree to the Terms and Conditions of The Lough Ree Distillery Ambassador Programme.