ONLINE APPLICATION

	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 # Please enter your membership number (If you are a former member and don’t remember your number we will find it for you.) Dues are non-refundable
	Date:

New members 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:

Title:
*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 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

Return Completed Application and Payment To:

Linda Henry
Membership Chair
6558 Red Hill Road,
Boulder, CO 80302-3400
Phone: (303) 443-8185
E-mail: inliners.member@gmail.com

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.

Payment By Check - Inliners International