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CENTRAL VIRGINIA CORVAIR CLUB Formed in
1979 Membership
Application Form Name:___________________________________ Birth Month/day:______ Street:________________________________________________________ City:___________________________________ Zip:__________________ Telephone:Home_____________ Work
or cell (optional)____________ Email
Address:_________________________________________________ Profession:____________________________________________________ Spouse's
Name:__________________________ Birth Month/day:______ Children's
Names:_______________________ Birth Month/day:______ _______________________ Birth
Month/day:______ Corvair(s)
you own:____________________________________________ _______________________________________________________________ _______________________________________________________________ Corvair
skills:________________________________________________ Other
hobbies:_________________________________________________ Dues
enclosed: Central Virginia Corvair Club...($12/yr*) $_____ (*Note: Pro-rate @ $1/mo to July - see
below) Corvair Society of (**Recommended. Do not pro-rate. Not applicable if CORSA member
already) Total enclosed.............................
$_____ CVCC annual dues expire each July 1. Dues are pro-rated at $1.00 per full
month you belong until the next July. For example, if you join in October, your
dues are $9.00. If in join in February,
your dues are $5.00. Please make
checks payable to Central Virginia Corvair Club Mail
to: Central Virginia Corvair Club |