Greene County Regulators Membership Application

Date_____________

Primary Member Name_____________________________________

Primary Member Alias______________________SASS #__________

Family Member Name_______________________________________

Family Member Alias_______________________SASS#___________

Family Member Name_______________________________________

Family Member Alias_______________________SASS#___________

Family Member Name_______________________________________

Family Member Alias_______________________SASS#___________

Family Member Name_______________________________________

Family Member Alias_______________________SASS#___________

Are you a NRA member_______ NRA member #__________________

Mailing Address____________________________________________

_________________________________________________________

Membership dues are payable on January 1st of each year. Family membership is $50.00 per year. Individual membership is $30.00 per year.

Members that join after the June monthly match will have their membership dues pro-rated. Family -$25.00 Individual - $15.

Type of membership (circle one) Family Individual

Amount paid___________

Make checks payable to: The Greene County Regulators

Simply bring this to a match and ask for Cumberland Mountain John or:

Mail to: Greene County Regulators

231 Norfolk Circle, Harrogate, TN 37752