Please complete the application form below and mail to:

 

Jean Weigt

14 East Main Street

Winters, CA  95694-1717

Phone:  (530) 795-0224

E-mail:  weigts@sbcglobal.net

 

 

 

YES!  I would like to join INLINERS INTERNATIONAL.  Enclosed is my check or money order (payable to “Inliners International”) for:  (please check one)

U.S. DUES

[   ] 1 year $28

[   ] 2 years $54

[   ] 3 years $78

[   ] 4 years $100

[   ] 5 years $120

OVERSEAS AND CANADA (U.S. funds only)

[   ] 1 year $38

[   ] 2 years $74

[   ] 3 years $108

[   ] 4 years $140

[   ] 5 years $170

 

(NOTE:  information provided will be included in Club’s annual roster unless otherwise instructed)

If you are a former member, please enter your membership number here:  _________ (we’ve saved it for you!)

Name _________________________________________ Associate (spouse or family member) ____________________

Street ___________________________________________________________________________________________

City/State ______________________________ Zip _____________ Country (if other than U.S.) ___________________

Primary Phone (______) ____________________ E-mail Address ___________________________________________

Vehicles:  (list maximum of 3)

Year                 Make                            Model                           Engine

_______            ______________            _______________          ________________

_______            ______________            _______________          ________________

_______            ______________            _______________          ________________

PRIMARY automotive interest (e.g., cruising, drag racing, Bonneville, street rods, swap meets, customs, oval track, etc.)

 

________________________________________

(please specify ONE area only)

 

How did you hear about us:  (please check one)

[   ] website                                           [   ] word-of-mouth

[   ] advertisement                                  [   ] other (please specify): __________________________)

 

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