SLATE BELT CORVETTE  CLUB

On-Line Membership Application

 Please Print Clearly

NAME__________________________________________________________________

SPOUSE_______________________________________________________________

ADDRESS____________________________________________________________

CITY ____________________________________ STATE________ ZIP__________

PHONE  (_____)  __________________ days   (______) _________________eves.

E-MAIL ADDRESS: ______________________________________________________

 

YEAR ____________  CP ______  CONV_______ COLOR ________ENGINE_______

TRANS____________  SPECIAL OPTIONS___________________________________

 

YEAR ____________  CP ______  CONV_______ COLOR ________ENGINE_______

TRANS____________  SPECIAL OPTIONS___________________________________

 

Check Off Any Corvette Activities That Are Of Interest You :

Car Shows_____ Cruises _____Caravan Trips _____ Dances _____ Parties ______

Picnics ______   Fun Runs ______ OTHERS _________________________________

Birthday ( Month & Day ) ____________   Wedding Anniversary ____________

Please Indicate Your Choice of Membership

____ Single  Annual  Membership  Fee =  $10.

____ Couple's Annual Membership Fee =  $20.

 

Total Dues Enclosed  $ _________

SIGNATURE______________________________________________ DATE_________

I hereby agree to abide by all the rules set forth in the Slate Belt Corvette Club By-Laws and understand that this application is subject to the approval of the club before I am granted full membership . Monthly meetings are held the 2nd SATURDAY of each month at 9am .

 

If you were referred to the club by a  S.B.C.C. Member , please include his/her name below :

Member's Name ______________________________________________

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Please mail this Application & Membership Dues to the following address :

SLATE BELT CORVETTE CLUB , 1040 Richmond Road , Bangor, Pa. 18013