(Please fill out and return to the Club President or Membership Officer)

*Dues are currently $30 per year plus $10 for family member 

                 Send To: Corvettes Of Clarksville, P.O. Box 20056, Clarksville, Tennessee 37042

                          Name ____________________________________Date_______________

                          Spouse/Other_________________________________________________

                          Year/Model/Color Corvette(s) do you own? ________________________

                          ____________________________________________________________

                                  Address_______________________________________________________

                          City/State _____________________________________Zip_____________

                           Home Phone ________________ Bus. Phone________________________

                          Birth Date: __________________Spouse’s Birth Date:__________________

                         (Birth Year is not required)

                          Email Address: _________________________________________________

 What type of activities are you interested in:    Autocross  Car    Shows  Parades  National Events  Cruise In  Road tours

 We like to show member pictures on our web site: I consent__  Do Not__

 Recruited  By:___________________________________________