Membership Application Form

Corvettes of Berkshire

Name: __________________________________ Date-Of-Birth: __/__/__
Spouse/Significant Other: ______________ Date-Of-Birth: __/__/__

Address: ________________________________________________________
City: _____________________ State: __ ZIP: _____
Home-Phone: _____________________________________________________

Anniversary-Date: __/__/__ (Birthdates + Anniversary-Dates for
use in Club Announcement Calendar)

Children's Names: ______________________ Date-Of-Birth: __/__/__
______________________ Date-Of-Birth: __/__/__
______________________ Date-Of-Birth: __/__/__
______________________ Date-Of-Birth: __/__/__

Year of Vette(s): _______ ________ ________
Color: _______ ________ ________
Model: _______ ________ ________

What type of events do you enjoy? _______________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________

ALL INFORMATION IS KEPT CONFIDENTIAL
Feel free to e-mail inquiry to Nate

Please enclose check for $20 annual dues payable to Corvettes of Berkshire.
Mail Application Form to: CORVETTES OF BERKSHIRE
PO BOX 1044
PITTSFIELD, MASS. 01202-1044

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