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Priority Club Membership Application-2009
Complete and mail back this form to join the IMDA Priority Club,
or fax it to us at (217) 753-8897. You can also join by calling (217) 753-8866 or Toll Free (888) 468-1622.
Annual Membership (1/1/09 - 12/31/09) $50.00
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Name
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Address
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City State Zip
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Phone E-Mail Address
[ ] Check [ ] MasterCard [ ] Visa [ ] Discover
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Account Number Expiration Date
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Signature
Illinois Motorcycle Dealers Association
2000 E. Cornell Street
Springfield, Illinois 62703
Phone: (217) 753-8866
Toll: Free: (888) 468-1622
Fax: (217) 753-8897
Web-Site: www.illinoismda.com
Email: info@illinoismda.com
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