Fill out the application below and click on the "SUBMIT" button when finished. This will send your application to us for processing.


PEACH STATE CORVETTE

Application for Membership

Names:

StreetAddress:

City, St., Zip:     

E-mail address:

Home Phone:   

Mobile Phone:

Office Phone:  

CORVETTE INFORMATION

                                                        1st Corvette                           2nd Corvette                            3rd Corvette                           4th Corvette

Year:         Year:         Year:         Year:

                                        Color:        Color:        Color:       Color:     

Dues for 2006

Existing Member(s) Single $25.00 Couple $40.00

New Member(s) Single $30.00 Couple $45.00

(Due's payable at next meeting)

Club Shirts

For Members $26.50 ea. Payment attached Yes_____ No _____

Male Size (S,M,L,XL,XXL) Female Size (S,M,L,XL,XXL) Color of name on shirt:

Name Tags

For Members $5.00 ea. Please order me name tags

Type the names as you want them to appear:

                                           Comments:

Note items with an asterisk (*) that are to be kept confidential Ver Feb 2006