APPLICATION | rgamerica

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Online Membership Application & Payment

Application Type *

New Application

Renewal

First name

Last name

Membership Year

RGA Number (For Renewals Only)

Alias

Street Address

City

Region/State/Province

Postal / Zip code

Phone

Email

Group Associations

My Interests (select as many you like)

Old West Performances

Historical Portrayals/Living Histories

Encampments

Other (specify)

Specify Other Here:

Select One: *

My information can be shared within the organization to keep me informed about RGA

Please do not share except with the National office and my State Director

Upload FULL-LENGTH Image

Upload supported file (Max 15MB)

NOTE FOR NEW MEMBERS:

Terms & Conditions

I agree to the terms & conditions

Is Re-Enactor 18 Years of Age or Older? *

Yes

No

Guardian First Name

Guardian Last Name

Date of Application

Select an item ($) *

Single Membership with RGA Insurance - $45

Youth (Under 18) - $25

Your Signature (or Guardian if under 18)

Thanks for submitting!

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