CORVETTES UNLIMITED CORVETTE CLUB,INC. VINELAND, NJ
                                     MEMBERSHIP APPLICATION FORM - PLEASE PRINT
                               (Note: Corvette Ownership is a prerequisite)

OWNERS  NAME___________________________________D.O.B.(MM/DD/YYYY______________

CO-PILOT'S NAME_________________________________D.O.B.(MM/DD/YYYY) _____________

ANNIVERSARY DATE (If Applicable) (MM/DD/YYYY)________________

ADDRESS_______________________________________________________________________

CITY________________________________STATE_______ ZIP __ __ __ __ __ - __ __ __ __

PHONE: HOME ______-______-________ MOBILE PHONE _______-______-________

If any of these numbers are unlisted, do you want them unlisted in the Club Roster?
Home Phone- Yes_____ Mobile: Yes_____ (If "Yes" to any above, use will be limited to Club Officer use ONLY!)

  E-MAIL #1 ________________________________________________________________

  E-MAIL #2 ________________________________________________________________

YEAR(S) OF 'VETTE(S) ____________ COLOR(S) _________________________________

BODY TYPE: COUPE_____ CONV._____ ZO-6 _____ ZR1______

V.I.N. NUMBER(S) ______________________________________________________

INTERESTS: (CHECK ALL APPLICABLE) SOCIAL EVENTS___ CRUISES___ SHOWS___
FUN RUNS_____ (Breakfast, Brunch, Ice Cream, Etc.)

MEMBER'S SIGNATURE______________________________________DATE__________

SPOUSE/CO-PILOT SIGNATURE_______________________________DATE__________

DUES- (Note: Dues run from January to December, regardless of Date Of Membership.  If
you join in October, November or December, then dues are paid for the following year as well)
MEMBERSHIP - $35.00/YEAR (INCLUDES CO-PILOT AS FULL MEMBER)

PLEASE MAKE CHECK PAYABLE TO: CORVETTES UNLIMITED, ENCLOSE WITH APPLICATION AND MAIL TO:

CORVETTES UNLIMITED
c/o SECRETARY
1518 MAGNOLIA ROAD VINELAND, NJ 08361-6535

(Updated 01/31/2010)