@w‘hj (a - tripodcorvettewv.tripod.com/webonmediacontents/scan jul 29... · 2017-07-30 · wnw/a...
TRANSCRIPT
WNW/a IA’ VA”§_“#51:.” L' .‘ v
u u ,CORVETTE CLUB
CHARLESTON. WV -
Kanawha Valley Corvette Club
The Oldest Corvette Club in West Virginia
____L_L_MembershiAlication
Nm.‘
AMess.‘
Spouse/Comm1'on.'
Phone.‘
W1'1.'
beof Conette
Year/s.'Color.-Bow Style.-Engl'ne.'
m'scellmeous Interest.-Cm1’ses/Tous.'Soc1'al Act1'v1't1'es.‘Autocrosses.'Car Shows.-Ralll'es/Econow Rms.'
Date Jal'ned.'
Charles Stephens, WCC Govemorm;‘1.— gstehecr2@w1’natrem.net
Send Cowleted Fom & fleck To.-Pegg Stephens, WCC Treasurer54521 State Route 681Ree®v1'lle, OH 45772-9073m;’l.- @3tehecr28w1‘nfitrem.net
Cell Phone.-
Wmt Pal'd.'
Inl'tl'al Mmershl'p Wes.' $45.00Prm'q Renewal Wes.“ $35.00
$0use/Comm1'on.' $20.00We check pay$le to.-
Kanawha Valley Conette Clw
wpll'catl‘on Rev1'sed.' 09-01-2017
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NCCC Membership ApplicationPlease print or type all infonnation.
Club Affiliation:Male:
Female: NCCC #Male:
Female: NCCC#Male:
Female: NCCC #
Primary:
Spouse/Companion:
Youth:
Youth’s Date of Birth:Youth’s Primary NCCC #
Address:
City State&Zip:
Email Address:Email Address:Email Address:
Primary: Phone #:Spouse/Companion: Phone #:Youth: Phone #:
__—pLevelsof Mem bershi
Primary $35.00 (New or Late Renew)Spouse/Companion $ 10.00
Youth $ 10.00 (16-21 years old under the Membership of a Primary Member)Lifetime Member $335.00 (one time charge)Member-at-Large Primary $35.00 (Not in an NCCC Corvette Club at this time)Member—at—Large Spouse/Companion $10.00 (Not in an NCCC Corvette Club at this time)Associate $35.00(fill—in primary information above, former NCCC member without Corvette or club)Enthusiast $35.00 (New)
Transfer from club #Change of name, address, or car (circle change(s)Previous NCCC Member NCCC# What year?
Corvette Information
Coupe, Convertible, Fixed Roof, 206, or ZR] (circle one)Year:
Applicant Signature(s): 3___________________ Date:
Date:X
This certifies that I am at least 16 years of age.
The annual pn‘mary dues for NCCC membership includes $10.00 for a one-year subscription to the NCCC BlueBars publication. These dues are for the year
Date:RMD Initials:
Revised 20-Apr—20] 6
@W‘HJ (a