ONLINE APPLICATION

Title of the document

	YES! I would like to join INLINERS INTERNATIONAL (NOTE: information provided will be included in Club's annual roster unless otherwise instructed) NEW MEMBER FORMER MEMBER Dues are non-refundable

Applicants are asked to complete the following information. Starred items(*) are required.
After completing this form, click ‘Submit’. A copy of this application will be emailed to you. Or you can also print this form and mail it to the address below.

Member Information:

*First Name:
MI:
*Last Name:
Suffix:
Nickname:	(Badge Name)

Spouse/Partner Information:

First Name:
MI:
Last Name:
Nickname:

Mailing Address:

Address1:	(Address)
Address2:	(Ste/Suite)
City:
State:
Province:
Postal Code:
Country:

Phones(s) (All listed phone numbers will be published in the Club's Roster):

Home Phone:
Cell Phone:
Cell Carrier:
* EMail:

PRIMARY Automative Interest(s) (check up to 3):

Cruising
Customs
Chapter Meeting
Drag Racing
Speed Racing
Street Rods
Swap Meets
Oval Track
Other

*INLINE* Vehicle(s):

Year	Make/Model	Engine

How did you hear about us?

Website
Swap Meet
Car Show
FaceBook
Advertisement (who)

Other Sources, please specify
Member:

Subscription Type	1 Year	2 Year	3 Year	4 Year	5 Year
All new/returning members receive decals, a membership card, and the club's by-monthly magazine The 12 Port News. Members are entitled to free classified advertising, access to member-only website features, and participation in all club and chapter events. HAVING AN INLINE ENGINE IS NOT A REQUIREMENT FOR MEMBERSHIP
US-Basic	$32	$62	$90	$116	$140
US-w/Roster	$38	$74	$108	$140	$170
US-1^st Class- Basic	$44	$86	$126	$164	$200
US-1^st Class-- w/Roaster	$50	$98	$144	$188	$230
Please remit international dues in U.S. funds only, please
Intl-Basic	$42	$82	$120	$156	$190
intl-w/Roster	$48	$94	$138	$180	$220

Susie Willis
Membership Chair
11495 West 20th Avenue
Lakewood, CO 80215-1268
(303) 279-3676
E-mail: membership@inlinersinternational.org

If you are paying by check, please print the completed application now. Click here to print.

ONLINE APPLICATION

Thank you for applying for membership with Inliners International.