Club Corvette of Connecticut, Inc

Club Corvette of Connecticut, Inc.
PO Box 120236 East Haven CT 06512
INTERNET APPLICATION FORM
Print & fill in this form, Send it to Club Corvette of Connecticut with a $60 check

Date of Application:___________________

Applicants Name:______________________________________________________

        Married:______Single:_______

If Married, Spouses Name:_______________________________________________

If NOT Married, Significant Others Name:_________________________________
            (Non-Voting Member)

Address:_____________________________________________________________

City:________________________________________State:______Zip:__________

Telephone Home:___________________Work:____________________Cell:_____________

Applicant's Birthday:_______/________Spouse's Birthday:_________/__________

Significant Other's Birthday:_______/________ ...Birthdays Month/Day ONLY

Year:__________Coupe:____Roadster:____Color:__________________________

Occupation: Applicant____________________Spouse ________________________

        Significant Other:_______________________________

Will you be able to attend meetings? Yes_______No________

Will you be able to attend activities? Yes_______No________

Hobbies or other interests:________________________________________________

Club Member that sponsored you:________________________________________________

Email Address:________________________________________________

NOTE: The Club's newsletter is posted on the "Members Only" page of our website. However, do you still want the newsletter mailed to you?      Yes_______No________

Please print and return this form, with your check for $60 to cover FIRST Year Dues from the date this application is approved. The subsequent years dues will be $45 per year.  Make the check Payable to :

Club Corvette of Connecticut, Inc.
PO Box 120236 East Haven CT 06512