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"