International Modena Club
Established 2003
 Membership Renewal

Enter information, print form & mail with check or money order to the address below!

Name:

E-Mail Address:
Spouse:

Address:

Address:

Address:

City &
Province:

State:

Zip Code:
Country:

Phone:

Area Code:
Number:    

Date of Birth:
(Mo/Day/Yr)

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Membership Dues:
Please select the membership renewal of your choice:

Individual Membership:
(Inside USA)		 $25.00
 I wish to receive the electronic edition of The IMC Quarterly (E-Quarterly).
Individual Membership:
(Inside USA)		 $25.00
 I wish to receive The IMC Quarterly as a hardcopy via mail delivery.
     
Individual Membership:
(Outside USA)

$25.00

 I wish to receive the electronic edition of The IMC Quarterly (E-Quarterly).  Refer to the IMC Bylaws Section 2 for explanation of membership fees.
Individual Membership:
(Outside USA)

$35.00

 I wish to receive The IMC Quarterly (E-Quarterly) as a hardcopy with postal delivery.  Refer to the IMC Bylaws Section 2 for explanation of membership fees.
     

Spouse Membership:

$10.00

Spouses who meet the requirements for individual membership may join the club for a $10.00 fee, but will not be eligible to vote or hold office, nor will they receive separate mailings. A spouse that wishes to vote must be an individual membership.
     
Junior Membership: $15.00
 Individuals 17 years or younger on January 1 and meet the  requirements for membership may join for $15.00 and will be entitled to full individual membership privileges.  Junior members between 12 and 17 are allowed to vote.
     
Affiliated Club Membership: $25.00
 Affiliated Clubs shall not have voting privileges in any IMC election.

I agree to abide by the rules of the IMC.  Enter your name in the box below to confirm that you will abide by the rules of the International Modena Club.

         Member's Signature:       Date: //

Mail Application and Membership Fee To:

B. Tim Taylor
Secretary/Treasurer
10032 Goodrich Road
Bloomington, MN 55437-2413
USA