Please print this Membership Application and mail with your check for $35.00 to:

Clubvette, P.O. Box 8541, Greensboro, NC 27419

[  ] New Membership-$35.00   [  ] Renewal  [  ] Update                    *Join Date: _________________

(Please check one of the above) (Please Print Clearly)

*Name:_______________________________________________________________________________

*Address:____________________________________________________________________________

_____________________________________________________________________________________

*City________________________________ *State _____________ *Zip Code ________________

*Phone: Home (_____)________________*Work (_____)________________ Cell: (_____)______

Email: _______________________________________ *Birthday: (mm/dd/yy) ________________

Occupation: _______________________________________________________________________

*Spouse Name: _______________________________  *Birthday(mm/dd/yy)___________________

*Anniversary Date: (mm/dd/yy) _______________________________________________________

GENERAL CAR INFORMATION - *Currently Owned Corvette(s):

Year: _____________________ Color: __________________   Coupe/Convertible/FRC: ________

Year: _____________________ Color: __________________   Coupe/Convertible/FRC: ________

Year: _____________________ Color: __________________   Coupe/Convertible/FRC: ________

*Special License # (if for more than one car, please indicate which car it goes with)

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