P.O. Box 380394
Murdock, FL  33938-0394

A Corvette Club for the Enjoyment, Restoration and Preservation of Corvettes

MEMBERSHIP APPLICATION

Please complete this application and return to CCC.  Members are required to:

• own a Corvette (any year) or intend to purchase one;

• have a current driver’s license;

• have current automobile insurance; and

• be at least 21 years of age.

Please Print

LAST NAME_______________________  FIRST_______________________  BIRTHDAY____________

SPOUSE’S NAME__________________________  ANNIV________________  BIRTHDAY____________

ADDRESS__________________________  CITY_________________  STATE_______  ZIP__________

E-MAIL_____________________  HOME PHONE___________________  CELL____________________

YOUR OCCUPATION________________________  SPOUSE’S OCCUPATION ______________________

DRIVER’S LICENSE# __________________________  INSURANCE CO.__________________________

WHAT CORVETTE(S) DO YOU OWN?

Year_______  Model___________________  Color______________  HP_________  Plate#__________

Year_______  Model___________________  Color______________  HP_________  Plate#__________

Do you have a web site/web page about your corvette? URL:___________________________________

Are you a member of any other Corvette Club(s)? ___________________________________________

How did you hear about our club?  _______________________________________________________

Other Interests/Hobbies________________________________________________________________

SIGNATURE____________________________________________  DATE ________________________

Annual membership fee is $30 (spouse is included free).  There is a one-time initiation fee of $25 per person.  New members receive our monthly newsletter, By-laws, CCC placard and club polo shirt with CCC logo & your name.

Please make checks payable to CCC