FAIRBANKS CORVETTE CLUB

MEMBERSHIP APPLICATION

 

(PLEASE PRINT)

NAME: ______________________________________________________

 

DATE OF BIRTH _________________ AGE __________ SEX _________

 

MAILING ADDRESS __________________________________________

 

RESIDENCE ADDRESS (OPT) __________________________________

 

EMPLOYMENT/OCCUPATION _________________________________

HOBBIES/SPORTS ____________________________________________

ORGANIZATION MEMBERSHIPS _______________________________

_____________________________________________________________

YOUR CORVETTE?  YEAR _________________ MODEL ____________

HOME PHONE ___________________ WORK PHONE ______________

E-MAIL ADDRESS ____________________________________________

MEMBERSHIP DUES

ACTIVE MEMBERSHIP: JAN – JAN, $24.00/YEAR

ASSOCIATE MEMBERSHIP: $3.00/MONTH FOR SIX (6) MONTHS

ABSENTEE MEMBERSHIP: $15.00/YEAR

 

QTY & TYPE OF MEMBERSHIP: ________________________________

_____________________________________________________________

AMOUNT ENCLOSED: ________________________________________

PLEASE SEND APPLICATIONS TO:

“FAIRBANKS CORVETTE CLUB

P.O. BOX 72605

FAIRBANKS, AK  99707”