Membership Application - Audi Club North America

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)
*Year :	*Model :
Year :	Model :
Year :	Model :
Year :	Model :
Year :	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:

$44 - 1 year
Add Family Member ($10 per individual):
1 - ($54 total) 2 - ($64 total) 3 - ($74 total)

$79 - 2 years
Add Family Member ($18 per individual):
1 - ($97 total) 2 - ($115 total) 3 - ($133 total)

$108 - 3 years
Add Family Member ($25 per individual):
1 - ($133 total) 2 - ($158 total) 3 - ($183 total)

$750 - Lifetime
Family member is included

Outside United States:

$52 - 1 year
Add Family Member ($11 per individual):
1 - ($63 total) 2 - ($74 total) 3 - ($85 total)

$94 - 2 years
Add Family Member ($21 per individual):
1 - ($115 total) 2 - ($136 total) 3 - ($157 total)

$132 - 3 years
Add Family Member ($29 per individual):
1 - ($161 total) 2 - ($190 total) 3 - ($219 total)

$750 - Lifetime
Family member is included

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. Exceptions: Cannot vote or hold office. 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 and Discover.

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