Lanier Corvettes Unlimited
Membership Application
NAME: ______Spouse: ______
Address: ______
City: ______State: ______Zip: ______
Home Phone # (____) ______Work #: (____) ______Cell #:(___)______
Emergency contact name: ______Phone #: ______
Email (primary member) : ______
Email (spouse): ______
Spouse Phone # (____) ______Work #: (____) ______Cell #:(___)______
Birthday(s): Month_____ Day______Month_____ Day_____
Are you acquainted with a LCU member? Yes ___ No ___ Name: ______
What club activities are of greatest interest to you? Club car shows
Technical seminars Cruise In's Work on members' cars Week-end Cruising
Corvette(s) Owned: (Year, style, color, coupe, convertible, engine, restored, etc.)
1) ______
2) ______
3) ______
______
Member Signature Date
______
OFFICE USE ONLY: Date and initial each item when completed
NCCC Docs filed ______Name Tags ordered _____ Added to Email list _____
Added to member roster _____ By-Lays signed _____ New member packet _____
______
Please mail to: Lanier Corvettes Unlimited
P.O. Box 717
Oakwood, GA 30566