Membership Application
To pay by mail, Click Here to download the PDF Application form. Adobe Acrobat reader required.

Membership Information
Please complete all information for our member profile. This information helps us to serve you and your needs. Fields marked with a * are required.
A valid email address is required and is for Audi Club use only.
*First Name :
*Last Name :
Company :
(if using Company address)
*Address :
 
*City :
*State/Province :
*Zip/Postal Code :
Country :
Work Phone :
(dashes only, 321-555-1111)
*Home Phone :
(dashes only, 321-555-1111)
Fax :
(dashes only, 321-555-1111)
Cell Phone :
(dashes only, 321-555-1111)
*Email Address:

Vehicle Information :
(If TT enter Roadster/Coupe)
*Audi Year :   
*Audi Model :
Audi Year :   
 Audi Model :
Audi Year :   
 Audi Model :
Non-Audi Year :   
 Non-Audi Model :
Non-Audi Year :   
 Non-Audi Model :


Additional Information :
Who is your Audi Dealer :
City :
State/Province :
*How did you hear about the Club?
*Did your Audi Brand Specialist refer you to the club? Yes No
Audi Brand Specialist name :
Comments are welcome

*Membership Dues:
($10 of your dues goes to the quattro quarterly publication)

All Amounts are in U.S. Dollars
United States:

Add Family Member ($10 per individual):

Add Family Member ($18 per individual):

Add Family Member ($25 per individual):
Outside United States:

Add Family Member ($11 per individual):

Add Family Member ($21 per individual):

Add Family Member ($29 per individual):
If you are adding a family member to your Membership, please enter their name(s) here. Separate more than one name with a comma.
Family member(s):

You must own an AUDI to name a family member.
A family member receives the same benefits as the member. Must be 18 years of age or older and reside in the same household. One Quattro Quarterly magazine per membership.

Please Note: If you enter in a family member name here, but do not select a Family Member option in the Members Dues above, your family member will be not be entered.
 

After completing this form, click Submit at the bottom of the page to complete your billing information. If you do not complete the billing information and pay online, your application is not complete and will not be entered into the database.

PLEASE VERIFY YOUR INFORMATION BEFORE PRESSING SUBMIT. PRESS SUBMIT ONE TIME ONLY, TO AVOID ANY DUPLICATE CHARGES.

We accept Visa, MasterCard, Discover and American Express.
 

If you prefer to pay by mail, Click Here to download the PDF Application form. Adobe Acrobat reader required.

*Club membership fees are non-refundable*


Questions call: 262.567.5476
Email: admin@audiclubna.org