The Corvette Society
P.O. Box 783
Levittown, New York 11756-0783 

MEMBERSHIP APPLICATION FORM 

Name: _________________________________________ Spouse/Other: ____________________ 

Address: ________________________________________________________________________ 

City: ________________________ State: ______ Zip: _________ Phone: ____________________ 

TELL US SOME INFORMATION ABOUT YOUR CAR 

Year: _________________  Body Style: q Coupe q Convertible Color: _____________________ 

Engine: _______________ HP: ____________ Trans. Type: q 4 Speed q Automatic 

Is your car: q Stock q Restored q Modified 

TELL US ABOUT YOURSELF, WHAT KIND OF ACTIVITIES DO YOU LIKE? 

Your Occupation: _________________________________________________________________ 

Do you have any experience judging cars? q Yes q No 

Do you like (check all that apply):    qShows qDisplays qCaravans q Social Events                                                                        qWeekend Trips qRoad Rallies 

Comments: ______________________________________________________________________ 

How did you hear about us? qFriend qPit Stop qShow qOther:____________________________ 

Have you ever been involved in a club before? qYes qNo 

Your E-Mail Address: _____________________________ @ ______________________________ 

Applicant’s Signature: ______________________________________ Date: ___________________

 The Annual Membership is $35.00 Per Year
Spouse or Significant Other is $5.00 additional.
Please make your check payable to:          The Corvette Society
                                                     P.O. Box 783
                                                                            Levittown, NY 11756-0783
(Please, do not send cash!)
________________________________________________________________________________
 

Application No.: __________________ Check #: _______________ Amount: ________________ 

(Please note: After July 1^st the dues through December 31^st are $20.00)