Membership Application

BICYCLE MOBILE HAMS OF AMERICA
C/O Mike Nickolaus, NF0N
316 E. 32nd St. - I
South Sioux City, NE 68776-3512

date _________  Individual (US or Canada) $ ___0___ Foreign $  ____0_____
Family (limit: two persons) $ ___0____  Donation $__________
New member? __________  Renewal? __________

Note that membership in BMHA is free.  At this time there are no dues, although donations are welcome.
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.

If you choose to donate, please make your check payable to BMHA, in US dollars or international money order.

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We currently do not publish a newsletter, but if we restart it, I will receive the BMHA Newsletter via eMail at the address above.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. 2007-11-01
instructions rev. 2016-10-30