CORVETTES UNLIMITED CORVETTE CLUB,INC. VINELAND, NJ
           
MEMBERSHIP APPLICATION FORM - PLEASE PRINT  (Note: Corvette Ownership is a prerequisite)

OWNERS NAME________________________________________D.O.B.(MM/DD/YYYY ______________ 

CO-PILOT'S NAME______________________________________D.O.B.(MM/DD/YYYY) _____________

ANNIVERSARY DATE (If Applicable) (MM/DD/YYYY)________________

ADDRESS___________________________________________________________________________ 

CITY________________________________STATE_______   ZIP  __ __ __ __ __ -__ __ __ __ 

PHONE: HOME ______-______-________    MOBILE PHONE _______-______-________  

If any of these numbers are unlisted, do you want them unlisted in the Club Roster? 
Home Phone- Yes_____    Mobile: Yes_____  

(If  "Yes" to any above, use will be limited to Club Officer use ONLY!)

E-MAIL #1 _________________________________________________________________  

E-MAIL #2 __________________________________________________________________	   
  
YEAR(S) OF 'VETTE(S)  ____________   COLOR(S) _________________________________ 

BODY TYPE:  HATCHBACK_____  CONV._____  Hardtop  ____  ZO-6 _____

V.I.N. NUMBER(S) ______________________________________________________

INTERESTED IN:(CHECK ALL APPLICABLE) SOCIAL EVENTS___ CRUISES___ SHOWS___ FUN RUNS_____

MEMBER'S SIGNATURE__________________________________________________DATE____________________

SPOUSE/CO-PILOT SIGNATURE___________________________________________DATE____________________

  DUES- (Note: Dues run from January to December, regardless of Date Of Membership,  unless 
  you join in October, November or December, then dues are paid for the following year as well)
 
  MEMBERSHIP  - $35.00/YEAR (INCLUDES CO-PILOT AS FULL MEMBER)
                                      
  PLEASE MAKE CHECK PAYABLE TO:  CORVETTES UNLIMITED, ENCLOSE WITH APPLICATION AND MAIL TO:
  
	CORVETTES UNLIMITED
	c/o SECRETARY
	1518 MAGNOLIA ROAD
	VINELAND, NJ 08361-6535 

(Updated 11/24/2007)