2014 PRGC Membership/Renewal FormPANHANDLE REGULATORS

 

Name:____________________________________________

 

Alias:_____________________________________________

 

S.A.S.S.#:___________________NRA#:________________

 

Address:__________________________________________

 

City:____________________State:_________Zip:_________

 

E-Mail Address_____________________________________

 

Phone:______________________

 

Membership Type:

 

Individual New ($35.00) Renewal ($25.00)

Family ($40.00) Renewal ($30.00)

Junior Membership (under 18 yrs) New ($25.00) Renewal ($20.00)

 

Make checks payable and mail to:

 

Panhandle Regulators, Inc.

7506 N. Campbell Rd

Otis Orchards, Wa 99027

 

For any questions please feel free to contact:

Buffy May 509-951-4763