Membershiprenewal2010

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  • 1. MAIL TO: Pacific Coast Corvette Club PO Box 14 Coos Bay OR 97420 MEMBERSHIP RENEWAL Dues are $30 per year per household (couple) Renewals are due by March 1, 2010 or your name will be omitted from the membership list. I/We hereby renew my/our membership in the Pacific Coast Corvette Club in the classification indicated above. I/We agree to abide by the Constitution and Bylaws of the Club and regulations governing its operation as adopted by the membership. NAME: ______________________________________________________________Birthday & Month _________________ ADDRESS: ____________________________________________CITY: ________________ ZIPCODE _________________ SPOUSE/OTHER: ___________________________________________________ Birthday & Month ______________________ HOME PHONE: ___________________________FAX: ___________________________CELL: ________________________ BUSINESS PHONE: ____________________________________ (do not list if you don’t want to be called) EMAIL ADDRESS: _____________________________________________________ Do you want your phone number to be published for others to see? YES __________ NO _____________ CORVETTE INFORMATION MODEL: _______________________________COLOR: _______________________ YEAR: _________________ SPECIAL FEATURES: __________________________________________________________________________ MODEL: _______________________________COLOR: ________________________YEAR: ________________ SPECIAL FEATURES: _________________________________________________________________________ SIGNATURE OF APPLICANT ____________________________________________________________________ Please return this form and your check to the address above. Thank you.