Membership Application

FALLS CITY CORVETTE CLUB EST. 1964

LOUISVILLE, KY

MEMBERSHIP APPLICATION

Name Birthday

Spouse's Name Birthday

Address

Wedding Annv. Home #

Work # Cell #

E-Mail

Year Style Color

Initiation Fees for New Members is $30.00 Per Person for the 1st Year.

Members Dues Yearly afterwards is $20.00 Per Person.

Membership Type ( X ) Single Couple

If dues are paid after September 30, you will be considered a Club Member for October thru December and your dues will apply to the following year's Membership.

PLEASE READ AND CHECK: FCCC dues shall be $20.00 annually per person. Dues are to be paid by January 31st of each year. If they are not received by that date, you will be required to pay a initiation fee of $10.00 plus your membership dues. Must be at least 18 years of age.

I HAVE READ AND AGREE TO THESE TERMS YES

SUBMITTED BY DATE

MAKE CHECKS PAYABLE TO FALLS CITY CORVETTE CLUB

MAIL TO:

FALLS CITY CORVETTE CLUB

C/O TROY BENNETT

P.O. BOX 21727

LOUISVILLE, KY 40221-0727

PAYMENT IS TO BE RECEIVED WITHIN 7 DAYS OF SUBMITTED APPLICATION

Please print a copy of this form and mail with Payment.