Individual Member Annual
Application Form

As a special promotional offer IANetwork is offering discounted annual memberships while we continue to build the network.   Regularly $30.00 we are making these available for $15.00. 
Please use this form to apply for your IAN Card, allow 2-4
weeks for processing/delivery.

Step 1: Complete the Application Form Below

Step 2: Return to this page and read the discaimer, select one of the choices below the disclaimer.

Note:
Please use your full legal name, some IAN Member Businesses
  require secondary forms of ID, and names should match on both ID's.

MEMBERSHIP APPLICATION

First Name:            Middle Initial:  

Last Name:  DOB(mmddyy):         

Home Address:

City:       State/Region:

Zip/Postal Code:    Country:

Home Ph.: Bus. Ph.: Ext:

e-Mail:         Gender:

Note: IAN periodically contacts members with information on special events, articles of interest, and promotions.  For the activities you select, we will put you on the mailing list for those category.  If you would prefer not to receive information on any of the categories you choose, please indicate in the check box at the end of the application. 

Which activities are you currently partcipating in or have in the past?

Ballooning Biking Camping
Canoes/Kayaks Culture/Arts Eco Tours
Equestrian Fishing Golf
Hang Gliding Hiking Laser Tag
Motor Sports Paintball Parasailing
Personal Watercraft Public Parks Sailing
SCUBA/Snork. Skiing Skydiving
Travel Whitewater Lodging

  Other:   

Which activities would you consider partcipating in?

Ballooning Biking Camping
Canoes/Kayaks Culture/Arts Eco Tours
Equestrian Fishing Golf
Hang Gliding Hiking Laser Tag
Motor Sports Paintball Parasailing
Personal Watercraft Public Parks Sailing
SCUBA/Snork. Skiing Skydiving
Travel Whitewater Lodging

Other:   

Referred by:

If IAN Member, what is member's number?:

Click on the Submit Form button to send in your application. 
Use your browser's back button to return to read the disclaimer.  Memberships cannot be processed without payment.


  


DISCLAIMER-PLEASE READ CAREFULLY: 
Before becoming a member of the IANetwork.com, I understand that my participation in any activiity highlighted on this website is done at my own risk.   I also understand that my participation in these activities could place me in harms way, and may require specialized training.  Furthermore I recognize that I.A.N., Inc. has no knowledge of any personal or physical limitaions that I may have; therefore I am solely responsible for judging what kind of activities that I should or should not engage in.  I accept that I.A.N., Inc. assumes no liability for my actions or for any problem that I may incur.

Choose the most appropriate statement.