CVC October 2013

CENTRAL VALLEY CORVETTES
MEMBERSHIP APPLICATION
NEW ________ RENEWAL ________ (Check one)
NO CHANGE __________(Check if all Information is the same since your last renewal, sign and return along with dues and a
copy of current insurance information)
MEMBER 1 __________________________________________________________DATE OF BIRTH _____________
LAST FIRST BADGE NAME (If different)
MEMBER 2 __________________________________________________________DATE OF BIRTH _____________
LAST FIRST BADGE NAME (If different)
ADDRESS _________________________________ CITY ___________________ STATE ________ ZIP __________
DATE OF WEDDING ANNIVERSARY _______________
MM/DD/YY
PHONE 1 _______________ _______________ ______________ _______________ ___________________________
HOME WORK CELL FAX E-MAIL
PHONE 2 _______________ _______________ ______________ _______________ ___________________________
HOME WORK CELL FAX E-MAIL
MEMBER 1 _______________________________ _____________________________ ______________________
EMPLOYER OCCUPATION DRIVERS LICENSE NUMBER
MEMBER 2 _______________________________ _____________________________ ______________________
EMPLOYER OCCUPATION DRIVERS LICENSE NUMBER
CORVETTES
YEAR _________ MODEL __________________ COLOR ________________ LICENSE _____________
YEAR _________ MODEL __________________ COLOR ________________ LICENSE _____________
YEAR _________ MODEL __________________ COLOR ________________ LICENSE _____________
THE UNDERSIGNED DESIRES TO ENTER AND PARTICIPATE IN CENTRAL VALLEY CORVETTES. IN CONSIDERATION OF THE
ACCEPTANCE OF THIS MEMBERSHIP APPLICATION THE UNDERSIGNED DOES HEREBY RELEASE CENTRAL VALLEY CORVETTES, IT'S
DIRECTORS AND ALL OTHER PERSONS AND ENTITIES INVOLVED WITH THE ORGANIZATION FROM ANY AND ALL LIABILITY FOR
INJURIES OR DAMAGES WHATSOEVER TO PERSON OR PROPERTY THAT MIGHT OCCUR WHILE PARTICIPATION IN THIS
ORGANIZATION. THE UNDERSIGNED AGREES TO ABIDE BY THE CURRENT BY-LAWS OF CENTRAL VALLEY CORVETTES.
MEMBER 1 ______________________________ ________ MEMBER 2 _______________________________ ________
SIGNATURE DATE SIGNATURE DATE
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Remember to turn in the following:
1. Membership Form
2. Dues - (Check made to “CVC”)
3. Copy of Current Insurance Information
The above is required for membership and membership renewal and must be received by the Dec. meeting but no later than Dec.
31. Please give to membership person or mail to:
CVC
P.O. Box 26591
Fresno, CA. 93729-6591
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INTERNAL USE ONLY
AMOUNT RECEIVED $ _________________ DATE RECEIVED _______________ CHECK # ___________
COPIES TO: MEMBERSHIP, SECRETARY