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

Gift Membership Information:
*Gift Membership For:
Gift Membership From:
For billing purposes, we need your complete information.
*Your First Name :
*Your Last Name :
*Your Address :
 
*Your City:
*Your State/Province :
*Your Zip/Postal Code :
Your Country :
*Your email:
Confirmation will be sent to this email address and is for Audi Club use only.
*Your Phone:
(dashes only, 321-555-1111)


Gift Recipient Information:
*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:
If the gift membership is to be sent to a different address other than the one listed under "Gift Recipient" please fill in the information below:
Name :
Address :
 
City:
State/Province :
Zip/Postal Code :
Country :

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 :
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:

Add Family Member:

Add Family Member:
Outside United States:

Add Family Member:

Add Family Member:

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):

The Gift Recipient 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, Master Card, 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