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)