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International Membership Application

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Membership Level

Choose your Membership Level *

International 1 Year $52

International 2 Year $94

International 3 Year $132

Lifetime $750

Member Information

First Name *

Middle Initial

Last Name *

Company

Address *

Address (Optional)

City *

State/Province

Zip/Postal Code *

Country *

Home Phone

Work Phone

Cell Phone

Email *

How did you hear about the club? *

Friend or relative's name

Additional Family Information

First Name

Middle Name

Last Name

Email

Vehicle Information

Year

Audi Model

Year

Audi Model

Year

Audi Model

Year

Non-Audi Model

Year

Non-Audi Model

Dealer Information

Who is your Audi dealer

City

State/Province

Did an Audi Dealership Employee refer you to the Audi Club? *

No

Yes

Name

Position at the dealership

E-mail address

Comments

Comments are welcome

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