CAROLINA CORVETTES
APPLICATION FOR MEMBERSHIP
PLEASE NOTE: This form may be filled out and presented to the Club Governor; however,
the NCCC Membership Application form will also be required.
Date _______________________________
Name ____________________________________________________________________
Spouse/Companion _________________________________________________________
Address __________________________________________________________________
City ______________________________________State _____________Zip ___________
Home Phone (_____) _______ - ____________ Work Phone (_____) ______ - ________
Home E-Mail Address ______________________________________________________
Work E-Mail Address_________________________________________________________
Birthday (dd/mm) You: ______/______ SpouseCompanion: ______/______
Your Vette: _________ ____________________ ________ __ Coupe __ Conv.
Year Color Engine
YOU
SPOUSE/COMPANION
Club Initiation Fee
(One time only)
$10
$ 5
Club Dues
$5 per month + $2 Spouse
From _____ / _____ to _____ / _____
_______
_______
National Council of Corvette Clubs (NCCC)
Initiation Fee (One time only)
$10
$10
NCCC Annual Dues
$35
$10
Sub-Total
_______
_______
OPTIONAL:
Club Jacket - $25 (After one year’s dues are paid – Club picks up rest of cost.)
_______
_______
Grand Total
_______
_______
