THREE RIVERS CORVETTE CLUB

							                     THREE RIVERS CORVETTE CLUB
                                             P.O. Box 85
                                         SOUTH PARK, PA 15129

            MEMBERSHIP APPLICATION AND RENEWAL
              NEW MEMBER: _____ RENEWAL: _____ MEMBER SINCE: _____

NAME: _____________________________________________HOME PHONE: (_____) _______________
                                                BUSINESS PHONE: (_____) _______________

ADDRESS: _______________________________________________________________________________
                  (STREET)                      (CITY)                 (STATE)     (ZIPCODE)

MEMBER’S BIRTH DATE: ____ - ____                         OCCUPATION: _________________________
                             (MO.)   (DAY)


SPOUSE: __________________________________               OCCUPATION: _________________________

SPOUSE’S BIRTH DATE: ____ - ____
                         (MO.) (DAY)


EMAIL ADDRESS: ____________________________________________________________

                                YOUR CORVETTE’S INFORMATION

YEAR______ BODY STYLE_______ ENGINE________ H.P.________ TRANS_______ COLOR______

YEAR______ BODY STYLE_______ ENGINE________ H.P.________ TRANS_______ COLOR______

YEAR______ BODY STYLE_______ ENGINE________ H.P.________ TRANS_______ COLOR______

YEAR______ BODY STYLE_______ ENGINE________ H.P.________ TRANS_______ COLOR______
NAME(S) OF OTHER CAR CLUBS OR ORGANIZATIONS OF WHICH YOU ARE A MEMBER


CORVETTE CLUB ACTIVITIES IN WHICH YOU WOULD BE INTERESTED:

      MEMBERSHIP MEETINGS___ ROAD RALLIES___ CARAVANS___ AUTOCROSS___
      DRAG RACES___ SPORT CAR RACES___ CRUISES___ OTHER___________________

YOUR HOBBIES: _________________________________________________________________________

CLUB MEMBER REFERENCE: ____________________________________________________________

SIGNED: _____________________________________________________________ DATE: ____________

ANNUAL MEMBERSHIP DUES: $20.00 – INDIVIDUAL / $25.00 – COUPLE

RETURN APPLICATION TO:               THREE RIVERS CORVETTE CLUB
                                     P.O. BOX 85 - SOUTH PARK, PA 15129