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 COOKIE TREMBLEY, SECRETARY
183 LANDIS AVENUE
BRIDGETON, NJ 08302-4331
(Updated 05/16/2014)