RIVER
CITIES CORVETTE CLUB
Application for Membership
PERSONAL
INFORMATION
First
Name___________________________ Spouse's_______________________________
Last
Name___________________________
Spouse's_______________________________
Street_________________________________________________________________________
City_______________________
State _____________
Zip______________________
Home Phone_________________ Work
__________________ Cell __________________
Fax__________________________
Email____________________________________________
Wedding Anniversary
(Month/Day) _________________ No. of
Children_____________
Children's Name(s)____________________________________________
CAR INFORMATION
Year
Corvette
_________ Color________________
Type______________
Special Features
____________________________________________________
Year
Corvette _________
Color________________ Type______________
Special Features
____________________________________________________
NEW MEMBERS ONLY
Your primary reason/interest in
joining___________________________________________
_____________________________________________________________________________
Shirt Size: SM MED LG XL XXL _____________
Spouse's_________
You receive ONE River Cities Corvette Club
shirt per membership.
Initial Membership Dues: $55.00 Renewal
Dues: $30.00 (April 1 of each year)
Date Meeting Attended______________ Date
Dues Paid________________
SIGNATURE(S)______________________________________________
Application and membership fee may be mailed
to:
River Cities Corvette Club
c/o Charlie Simpson
Make checks payable to "River Cities
Corvette Club"