Membership Application

BICYCLE MOBILE HAMS OF AMERICA

date _________ 

New member? __________  Renewal? __________

Note that membership in BMHA is free.  At this time there are no dues. Donations are NOT requested..
BMHA may contact you infrequently (less than once a year) to confirm your continued interest and desire to stay current and on our mailing list.

Name _________________________________  Call __________

Address ________________________________ License Class ___________

City ___________________________  State _____________  Zip ____________

E-mail address __________________ @ _____________________

Year of birth ___________  Most miles bicycled in one day ___________________

We currently do not publish a newsletter, but if we restart it, I will receive the BMHA Newsletter via eMail at the address above.

rev. 2026-02-11