2010 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.

12115 E. Black Rd.

Chattaroy, WA 99003

 

For any questions please feel free to contact:

Rita Would:  509-238-6290 or  509-951-3377