Membership Application or renewal Form

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number *

Country

(###)

###

####

Membership Type *

For Membership descriptions please refer to the BRASA Constitution. (Contact the Secretary for a copy if required)

Ordinary Membership ($5 annual fee)

Club / Sustaining Membership ($50 annual fee)

Life Member

Special Member

Payment Method *

Direct Deposit

Cash (approval required)

Credit card

Proposed by *

First Name

Last Name

Seconded by *

First Name

Last Name

Is your group insured?

Yes

No

Photographs of BRASA Members may be used in various BRASA communications including local newspapers, newsletters, social media, displays and websites. Group photos taken at BRASA events may be used without identifying individual members. For individual photographs, please indicate your permission for use: *

BRASA has my permission to use and identify images of me.

BRASA does not have permission to use and identify images of me.

BRASA must contact me before using any identified images of me.

BRASA has permission to photograph and publish all/any members from the Group I represent

Applicant's Name *

First Name

Last Name

Submission Date *

MM

DD

YYYY