2010
TRI-LAKES CORVETTE CLUB
MEMBERSHIP APPLICATION
********
ANNUAL FEES: $50.00 per
couple or $35.00 per single
Amt. Paid: ___________ Cash____
Check____ Check #________
Primary Member:
_______________________________________________________
Birthday:
Month____________ Day___________
Spouse:
________________________________________________________________
Birthday:
Month____________ Day___________
Address:
_______________________________________________________________
City: ___________________________ State_______________ Zip
Code___________
Home Telephone #: _________________________________
Cellular #1:_______________________________________
Cellular #2:_______________________________________
E-mail Address: (PLEASE PRINT CLEARLY)
#1 _________________________________________________
#2 _________________________________________________
CORVETTE
INFORMATION:
Car #1:
Year________ Model _____________ Coupe
______Convertible______ Hard Top _______
Car #2:
Year________ Model _____________ Coupe
______Convertible______ Hard Top _______
Car #3:
Year________ Model _____________ Coupe
______Convertible______ Hard Top _______
Car #4:
Year________ Model _____________ Coupe
______Convertible______ Hard Top _______
Car #5:
Year________ Model _____________ Coupe
______Convertible______ Hard Top _______
Member’s
Signature __________________________________ Date ______________
Membership Fee DUE BY January 1st,
2010
(may be paid @ Club’s Jan. 8th monthly meeting if
attending)
********MAKE CHECKS PAYABLE TO LANA
ROBERTSON, TREASURER********
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