A club for the owners of the only true American made sports car

APPLICATION FORM

Name of Applicant____________________________________

Address ________________________________ZIP_________

Telephone #_________________________________________

E-mail Address_______________________________________

Year of Corvette_________Coupe/Conv___________________

Color of Car_________________________________________

Applicant’s Date of Birth Month ________Day___________

Married (  ) Single (   )          Spouse/Friend Name _________________________    DOB Month _________Day_______________

If married, Anniversary Date_________________________________________________

Annual Membership is $20.00/car (At this time)                                         Application Date______________________________

Please print, Fill out and bring to a meeting with your annual dues of $20.00