BHA Membership Application Form

BHA Membership Application

To apply for membership please complete all questions.
Membership is for a 12 month period from payment date.

(Payment can be made online or Credit Card by phone).
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*

Area CodePhone Number
Type of Membership*

RenewalNew MembershipGift Membership
Membership type*
prevnext( X )
Student with ID$15.00

Individual$40.00

*Couple$65.00

*Family (2 adults & children under 18yrs)$75.00

Patron (per person)$100.00

Heritage Circle (per person)$300.00

Corporate (limit 10 individuals)$750.00

Lifetime (per person with guest)$3,000.00

Total $0.00
*Couples & Families, please list immediate family members.
Should be Empty: