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 Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

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

Area Code Phone Number
Type of Membership *

Renewal New Membership Gift Membership
Membership type *
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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: