P.O. Box 525
 Carson City, NV 89702
                                                                                        www.laketahoecorvetteclub.org

        MEMBERSHIP APPLICATION 

   Date:  _____________                                                        
                                                                                                                                                       
 

   Name: _______________________________________________ Birthday (mm/dd) ________

   Spouse/Significant Other __________________________________ Birthday (mm/dd) _______

  Mailing Address: _______________________________________________________________________

   City:
______________________________________________ State ______  Zip _________

  Home Ph (    ) ______________ Cell Ph #1  (     )  __________ Cell Ph #2 (      ) _____________

  Email address #1: __________________________________________ For: ____________________

 
Email address #2: ___________________________________________For: ________________________

          Corvette Info:

              Year                         Color                                                      Special Information

_______         _________________________         _________________________________

_______      __________________________         _________________________________

________     __________________________        _________________________________

________     __________________________        _________________________________

Yearly membership dues are $30.00 per person.
New members pay an
additional
one-time only initiation fee of $15.00 per person.

Make check payable to LTCC and mail along with this form to:

         Lake Tahoe Corvette Club
p.o. box 525
Carson City, NV 89702