PRGC Order Form: Regular Dues

*Number of years' dues you're paying ($50/year):   

     (Not the dollar amount, just the number of years)

*Last name:   

*First name:   

*NRA #:   

     (Your NRA membership number. NRA Life members: enter the word "Life" here)

*NRA Expiration Date:   

     (Enter as: mm/dd/yyyy)

*PRGC Member Number:   

   (Get your PRGC Member Number from your membership card, or from the Membership Chair)