Application for Membership  

Name: ____________________________________________________________

Spouse Name: ______________________________________________________

Address: __________________________________________________________

               __________________________________________________________

Phone: (Home) _____________________________________________________

  (Work) _____________________________________________________

  (Cell Phone (s))_______________________________________________

  e-mail(s): ____________________________________________________

Celebration Dates:  Month/Day for birthdays and anniversary

Member:______/______, Spouse______/______, Anniversary_____/______

Corvette(s) year/model: _______________________________________________

Please print and then fill out the form clearly.

Dues are $40.00 per family or $25 per individual.

Make check payable to: Classic Corvettes KY

MAIL FORM WITH CHECK TO: Diane Metzgar