Rochester Corvette Club
Membership Application
Established 1959

Visit our website for meetings time and place…… www.Rochestercorvetteclub.org

Dues are $30 for an individual and $40 per couple, payable by January 1st of each year. Membership runs from January 1st through December 31st (after September 1st they are half price)

Please mail this form with your check payable to:
Rochester Corvette Club
P.O. Box 23972
Rochester, NY 14692

Membership Information………..Please print clearly…
If couple membership, please list both names.

New Member(s) _________ Renewal _________

Name: _________________________________________
Street: _________________________________________
City: ___________________________________________
State: _________ ZIP: ____________________________
Phone: _________________________________________
E-mail Address: __________________________________
Please check one:
          Send my Newsletter by mail _____
          Save a tree, I’ll read my Newsletter on the website _____

Corvette Information:

Year(s) _______ Model _____________ Color ______________
           _______           _____________          ______________
           _______           _____________          ______________
           _______           _____________          ______________
           _______           _____________          ______________

Please fill out: Dues amount ………………………$__________
                     Optional Car show donation $__________
                     Optional Charity donation……$__________
                     Total Enclosed………………………$__________

Download a PDF version of our Membership Application