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I want to (check one)

Join Boss Hoss Riders Association (includes magazine)[   ]  $50.00 Year*

*For International Orders* There will be an additional $30.00 US (To cover P&H)

Order  BHRA Coozie [   ] 2 for $ 5.00  Order  BHRA License Plate [   ] $5.00*

     Quantity__________________

Order Rally Pin [   ] $2.00*

     Quantity__________________

Order  T-shirt [   ] $18.95 Non Members* [   ] $15.00 Members*

     Quantity__________________

Order Patches  [   ]Small - $11.95*  [   ]   Large - $49.00*

     Quantity__________________

     *There will be a $5.00 S&H charge on all product orders

Credit Card Info:

Credit Card Type: (circle one) Visa  MasterCard  Amex  Discover

Credit Card #_______________________________Exp. Date__________________