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Address: ________________________________________________________________

City, State, ZIP ___________________________________________________________

Phone ___________________________________ email ______________________________

for club correspondence & notices

New Member ________ Renewal _____________ NRHA # ____________________

for Affiliate purposes

By signing below, I accept the Rules and Regulations relating to the current MRHA Rules and Bylaws which are available on the MRHA web site or in print, if requested.

Signature _______________________________________ Date _______________________

　Make checks payable to MRHA and send to

_______ $200 Life Membership　

Annual Memberships terminate December 31 of each year.

Please indicate below if you want your newsletter mailed to you or delivered electronically.

_______  MAILED                    _______________DELIVERED THROUGH EMAIL   (enter email address above)

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Office Use Only: Assigned member number: _______________________________

check # ____________________________ Date received __________________________

Membership list _____________________ Card printed ____________________________

Card sent __________________________