 |
|
|
|
|
| Application Form
|
| *field required for processing |
|
| *Select Membership type below: |
|
$75.00-New member, full year (Jan 1 - Jun 30) - Includes $35.00 Initiation Fee
$55.00-New member, half year (Jul 1 - Dec 31) - Includes $35.00 Initiation Fee
Amended Application
|
|
|
|
First Name |
Last Name |
DOB (mm/dd/yyyy) |
|
|
| *Owner: |
|
|
|
|
|
| Companion: |
|
|
|
|
|
|
| *Address: |
|
|
| *City: |
|
*State: *Zip: |
|
|
| Phone (Home): |
|
(Cell): |
|
|
|
| *E-mail: |
|
|
|
| *Driver's Licence #: |
|
|
| *Insurance Company: |
|
|
| *Policy Number: |
|
|
|
| Recruited By: |
|
|
|
|
Year |
Color |
Body |
Plate |
|
| *Corvette #1: |
|
|
|
|
|
| Corvette #2: |
|
|
|
|
|
| Corvette #3: |
|
|
|
|
|
|
Please use the space below to tell us a little bit about yourself/selves and your interest
in Corvettes. What you tell us will be printed in the Vette Gazette so other members in the
club can get to know you.
|
|
|
|
Please Read Carefully
I/We the undersigned, being of lawful age, do for myself, my heirs, executors,
and assignees, hereby release and forever discharge the Corvette Club of Utah, Inc.,
other participants, and/or individual, group, or corporation, or group of individuals
sponsoring the event, his/hers/their heirs, administrators, executors, of and from
any and every claim, demand, action, or right of action, of whatsoever kind of nature,
either in law or in equity, arising from or by reason of any damage resulting or to
result from any accident which may occur as a result of participation in any contest
or event sponsored by the Corvette Club of Utah, Inc. The terms of this agreement are
contractual and not mere recital. I/We further state that I/We have read the foregoing
release and understand the contents thereof, and I/We sign my/our name(s) as my/our own
free agent.
*By checking this box you agree to the above.
|
|
|
|
|
|
|
