| T I R E T O W N |
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| C O R V E T T E |
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Membership Application |
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| C L U B |
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DATE |
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MONTH/DAY |
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| NAME |
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DATE OF BIRTH - |
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| SPOUSE'S/SO NAME |
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ANNIVERSARY |
DATE OF BIRTH - |
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| ADDRESS |
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| CITY________________________STATE |
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ZIP |
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| HOME PHONE |
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WORK |
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E-MAIL |
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| CELL
PHONE |
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NO CHILDREN |
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AGES |
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| YEAR
CORVETTE(S) |
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COUP CONVT |
COLOR |
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| CUBIC INCH |
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H.P. |
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AUTOMATIC/4-SPEED |
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| NAME
OF EMPLOYER |
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OCCUPATION |
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| SPOUSES
EMPLOYER |
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OCCUPATION |
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| HOBBIES/INTERESTS |
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| HAVE
YOU EVER BEEN A MEMBER OF A CORVETTE CLUB _____________ |
NAME |
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YOU HOLD ANY OFFICES? |
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OFFICES HELD |
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| DO
YOU CURRENTLY BELONG TO THE NATIONAL COUNCIL OF CORVETTE CLUBS? |
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| WHAT
IS YOUR NCCC NUMBER |
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SPOUSE'S |
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BRIEFLY YOUR REASONS FOR DESIRING TO BECOME A MEMBER OF TIRETOWN CORVETTE
CLUB. |
| WHAT
ARE YOUR/SPOUSE'S CORVETTE
INTERESTS: SPEED EVENTS CONCOURS CAR SHOWS |
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| DRAGS |
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ECONOMY RUNS |
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SOCIAL |
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| HOW
DID YOU LEARN ABOUT TIRETOWN CORVETTE CLUB? |
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DUES |
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SIGNATURE |
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MEMBER |
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SPOUSE |
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$35.00 |
NCCC |
$10.00 |
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$20.00 |
TTCC |
$5.00 |
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$5.00 |
Initiation |
0 |
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$60.00 |
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$15.00 |
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| DATE APPROVED BY BOARD |
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PRESIDENTS SIGNATURE |
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| DATE
DUES PAID |
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NCCC NUMBER: |
EO-068 |
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EFFECTIVE |
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| DIRECT
ALL WRITTEN CORROSPONDENCE TO: TTCC, P.O. BOX 331, CUYAHOGA FALLS, OH 44222 |
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