CENTRAL VIRGINIA CORVAIR CLUB
Formed in
1979
Membership
Application Form
Name:___________________________________
Birth Month/day:______
Street:________________________________________________________
City:___________________________________
Zip:__________________
Telephone:Home________________
Work (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
America(CORSA)($35/yr**)$______
(**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
8015 Driftwood Dr
Prince George, VA 23875