Become a BHA Member
support and work on issues important to you

Name:
Address:
Daytime Phone Number:
Evening Phone Number:
E-Mail Address:

Please choice the category checked below:

	Senior $10		Individual $25		Household $40
	Patron $125		Donor $65		Benefactor $175

Method of Payment:

Check (payable to the Brooklyn Heights Association) or Credit Card:

MasterCard

Visa

American Express

Card Number: |____|____|____|____|____|____|____|____|____|____|____|____|____|____|____|____|
Expiration: ____/____
Signature: ________________________________

Tell us what you care most about by checking boxes below.

The BHA is lead by a volunteer Board of Governors. If you can help with membership tabling or staff
our Spring House Tour, check below. If you wish to receive email updates on issues affecting the Heights,
check off the area(s) of interest to you.

	House Tour		Membership Tabling
	Parks, Playgrounds		Historic Preservation
	Trees		Sanitation
	Planning and Zoning		Traffic
	P.S. 8		Safety
	Other _________________

We are a Non-Profit Corporation. Membership dues and contributions are tax-deductible to the extent allowed by Law. Your cancelled check is your receipt.

Complete this form and fax it to us at : 718-875-5607 or call the BHA office at 718-858-9193