VICTORIA CORVETTE CLUB

MEMBERSHIP APPLICATION FORM

(Please Print)

FULL MEMBERSHIP
	Name:
			Last Name				First Name
ASSOCIATE MEMBER
	Name:
				Last Name			First Name
	Address:
	City:					Postal Code:
	Home Phone:					Work Phone:
	Cell Phone:					eMail:
CORVETTE INFORMATION					(list additional Corvettes on back page)
	Year:				Model:			Color:
	Engine:				Transmission:		License #
MEMBERSHIP FEE
	Type of Membership							Fee	Amount
	Full Member	(includes membership to Canadian Council of Corvette Clubs)						$75/yr
	Associate							$20/yr
	(Membership renewal fee in following year is $70.00)
							Total Fees Due
	Signature:
	To be completed by the Membership Coordinator
	Cash		Cheque			Member #
	Date					Signature

ADDITIONAL CORVETTE INFORMATION
	Year:	Model:	Color:
	Engine:	Transmission:	License #
	Year:	Model:	Color:
	Engine:	Transmission:	License #
GENERAL INTEREST INFORMATION
	Please indicate the type of club activities you would be interested in
	Car Shows
	Rallyes
	Road Tours
	Slalom Racing
	Other Events
	Comments and/or suggestions