Date______________
CINCINNATI
CORVETTE CLUB MEMBERSHIP APPLICATION
(Member) (Member/Spouse)
(Street) (City) (State) (ZIP)
BIRTH DATE: ______________________
EMPLOYER:
_____________________________________________________________
BUS. PHONE: ______________________________________________________________________
DR. LIC. NO.:
_________________________________________________________________
INSURANCE CO.:
________________________________________________________________
(Name) (Agent) (Policy #) (Expires)
CORVETTE SPECS
Year:____________ _______________ ____________
Body Style:____________
_______________ ____________
Color:
____________ _______________ ____________
Engine: ____________
_______________ ____________
I
am a licensed driver and will not authorize the operation of any car, which I
own to participate in any Cincinnati Corvette Club event by an unlicensed
driver. I will not operate or authorize
the operation of any car, which I own, in any Cincinnati Corvette Club event,
unless Property Damage and Bodily Injury Insurance has been provided in amounts
equal to, or in excess of, the coverage required by §4509.20 of the Ohio
Revised Code (Financial Responsibility Law), as of the date of this
application.
Signed__________________________________________________________________ (for new members only)
ANNUAL DUES (check appropriate blanks and submit a
check payable to CCC)
New
Member (full year membership for one person)
_______ Active
Member CCC Dues - $22.00
NCCC Dues - $35.00 Total
- $57.00
Joint New Membership (Full Year
Membership for Member and Spouse, Companion, or Dependant)
_______ Active
Member (Couple) CCC Dues - $33.00
Plus NCCC
Members (couple) - $45.00 Total
- $78.00
* New Members must
join NCCC the 1st year.
Take note!!!!!!!!!! There are 5 different choices for
membership renewal.
RENEWAL DUES (Due to the Treasurer by November 20th)
_______ Active
Member Dues CCC only - $22.00 Total - $22.00
_______ Active
Member Dues (couple) CCC only - $33.00 Total - $33.00
_______ Active
single Member CCC Dues - $22.00
+ NCCC Dues - $25.00
Total – $47.00
_______ Active
Member (Couple) CCC Dues -
$33.00
+
NCCC Dues for one Member - $25.00 Total - $58.00
_______ Active Member (Couple) CCC Dues -
$33.00
+ NCCC
Dues for couple - $35.00 Total - $68.00
* - Half year Membership (after June 30) deduct
$11.00
** - Half year Joint Membership (after
June 30) deduct $16.50
Please send to:
Cincinnati Corvette Club
P O Box 24184
Cincinnati, Ohio 45224
CCC
c/o Chuck Jenkins
6345 Georgetown Rd.
Fairfield, Ohio 45014