Membership Form

VALPO  VETTES,  INC.

Membership  Application

(Dues Renewal Membership: $25.00 If Paid Between Jan. 1st And Feb. Meeting.)

($30.00 If Paid After February Meeting.)

(Dues New Membership: $30.00)

Name:___________________________________________ Spouse: _______________________

T-Shirt Size: ________                                                           T-Shirt Size: ________

Address: _______________________________________________________________________

City: ____________________________ State: ______________________ Zip: ______________

Home Phone: ____________________________ Cell Phone:_____________________________

2nd Cell Phone: _____________________________ Name: ______________________________

Provide cell numbers for communicating on cruises. Phone list to be issued for glove box.

Email: (Please print legibly.) _______________________________________________________

Birthdays: (Month/Day only) You: ______________________ Spouse: _____________________

Anniversary: ____________________________________________________________________

Year of Corvette #1 _______________ Color _____________ Convertible ______ T-Top _____

Year of Corvette #2 _______________ Color _____________ Convertible ______ T-Top _____

Year of Corvette #3 _______________ Color _____________ Convertible ______ T-Top _____

I have a Club Flag:               Yes: ______ No: ______

I have a Name Tag:              Yes: ______ No: ______

Signature: ____________________________________________________ Date: _____________

Valpo Vettes, Inc.–P.O. Box 61–Crown Point, IN. 46308           Website–valpovettes.com

Wavier of Libility