Membership Application for Corvette Club of America

Corvette Club of America, Inc.
World's Oldest Corvette Club (CCA), Established 1956
Member, National Council of Corvette Clubs (NCCC), ER-001

^{Application for Membership}^{Annual
Dues New $80.00 Renewal $55.00

Spouse (add NCCC):** $10.00

^{(Dues must accompany application)}}

^{(* includes CCA and NCCC membership for
the applicant and CCA membership for the spouse)

(** only if spouse is entering competitive events for NCCC points)}

Name:__________________________ Spouses Name:____________________________

^{Street Address: ____________________________________ Date of
Birth:_____________} ^{(minimum age: 21)
City: ____________________________ State:_______________
Zip:_______________} ^{Phone: Work (
)____________________Home (
)_________________________} ^{Email Address: ____________________________________

SURVEY INFORMATION:

Corvette: _________________ Year:_________
Engine/HP:_________________ Transmission:_____________
^{Body Style: __________Color: ___________License: (state,
#)___________} ^{Do you own any other Corvettes? _________Years:
____________________} ^{What types of competitive events have you entered:

What type of events have you worked on?

Skills useful to the club?}
^{Please circle events you would like to participate/assist
in:}
^{Shop Night (maintenance) Gymkhanas Autocrosses Picnics
Movies & Lectures Technical Rallys Tours Courier
(newsletter)
Other Competitive events Social events Elective office
What other sports car clubs are you a member of:
Why do you want to join CCA?
What are you looking for in our club?
How did you hear of CCA? Sponsor? WEB site?
Sponsors: 1)_________ 2)_________}

___________________________________    __________

Applicants
Signature
Date
^{Make checks payable to: Corvette Club of America, Inc.

Detach application and mail to:

Jean Wade, Membership

24716 Tandem Dr.

Damascus, Md. 20872}

Do not write below this line - for office use only
^{Date Joined: ______________Positions
Held:__________________________} ^{Amount, ABA: _______________________,} ^{Renewals: _________________Address
Change:________________________}}