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P.O. Box 6807
 Stateline, NV 89449
        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 $20.00 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
        C/O Barbara Coe
136 Trojan Dr.
Carson City, NV 89706