APPLICATION FOR INITIAL / RENEWAL MEMBERSHIP
VINTAGE CORVETTES OF SOUTHERN CALIFORNIA, INC.
1114 N. Everett St., Glendale CA 91207
Initial Application: ____ Renewal Application: ____ (Due by 1st Sat. in Feb.) Date Joined Club ____
(Please complete application in its entirety, even if a Renewal. Do not indicate “same as before”. Please print)
Membership Information:
Name: ______Birth date: ______Occupation: ______
Spouse: ______Birth date: ______Occupation: ______
Add’l Licensed Family for Membership Name: ______Birth date: ______
(Of driving age and living with member) Name: ______Birth date: ______
Mailing Address: ______City: ______Zip: ______
Home Phone: ______Business or Cell Phone: ______
Email Address(s) (if you want listed on the club roster): ______
______
Oldest Corvette: Year ______Color ______Lic No ______Yr Purch’d ____ Coup or Conv ____
Original or Modified ____ Engine Size ____ Horsepower _____ Transmission ______
Other Corvettes:(1) Year ______Color ______Coup or Conv ______
(2) Year ______Color ______Coup or Conv ______
(Please use back of Application for following information)
Other Clubs: Name of other Corvette Clubs to which you belong.
Event Interests: Please list events or activities that would be of interest to you.
Membership Dues: Membership Dues are for a period of one year. (Feb. to Jan)
Initial Membership Fee: (for all New Members, one-time fee):
______One Member ($15.00)
______Two or more Members ($17.00)
Initial / Renewal Fees: (for all new and renewal Members)
______Member ($50.00) Includes two household members
______Add’l Family Members ($10.00 ea)
Please make check payable to: V.C.S.C., Inc.
Send to: Loretta Loddo, 1114 N. Everett St., Glendale, CA 91207
I hereby agree, as a condition of my membership in VINTAGE CORVETTES OF SOUTHERN CALIFORNIA, INC., that I am joining this club for my own pleasure and will be fully responsible for my actions at all times. I fully understand that I am responsible for having in effect a current insurance policy, as required by State Law, on my vehicle(s) when used for any V.C.S.C. functions, events or activities, that will cover any accidents or incidents that I may be involved in during any club-supported events. I release VINTAGE CORVETTES OF SOUTHERN CALIFORNIA, INC., its assignees, officers, heirs, and all others, connected with the club, heretofore, from any liability, whatsoever. I also agree as a condition of my membership in VINTAGE CORVETTES OF SOUTHERN CALIFORNIA, INC., that I will not use the club logo or any club item with the V.C.S.C. logo or promotional purposes of any kind.
______
Applicant Date SpouseDate Sponsoring Member Date
For V.C.S.C. use:
Date Rec’d______
Fee Paid: ______Membership ____ President’s Signature Date Secretary’s Signature Date