Culpeper Corvette Club, Inc.
Membership Application

Name:______________________ _______ Email Address:________________________

Spouse/Other Name: ___________________________ Email Address: _________________

Birth Date: __________________________ Spouse/Other Birth Date: __________________

Anniversary Date: __________________________

Mailing Address: ____________________________________________________________

City: _____________________________ State: ____________ Zip Code: ______________

Phone: Area Code: _________ Number: __________________________

Corvette(s) Presently Owned:
Year(s)_______________Style ___________ Color _____________ Engine ____________

What kind of activities would you like to participate in with the Culpeper Corvette Club (example,

social events, car shows, cruise & eat, attend Corvette Carlisle, breakfasts, brunch, etc.)?

_______________________________________________________________________

What skills do you have that you might be willing to share with other members of the Club?

_______________________________________________________________________
Dues Information:

The Bylaws of the Culpeper Corvette Club require membership in both the Culpeper Corvette
Club and the National Council of Corvette Clubs.

Culpeper Corvette Club Payment Included for:
Membership Initiation (one per couple) ---------------------- $10 _________
Membership Annual Dues ------------------------------------ 15 _________
Spouse/Other Annual Dues ----------------------------------- 10 _________

National Council of Corvette Clubs (“NCCC”):
Membership Annual Dues, New Member ------------------- $35 _________
Membership Dues, New Member/Spouse ------------------- 10 _________

National Council of Corvette Clubs (Renewal only)
Annual Renewal (Member) ---------------------------------- $25 _________
Annual Renewal (Spouse) ----------------------------------- 10 _________

Total $ ________
Hint: The total should be $80 for a couple, as new members for both Culpeper and the NCCC
( National Council of Corvette Clubs). The total should be $60 for a single, new member.

Please make check out to the Culpeper Corvette Club for entire amount. We remit to the
NCCC for their portion.

Please send application and check to:

Bob Witt, President, Culpeper Corvette Club, Inc.
15200 St. James Ct., Amissville, VA 20106
Thank you.

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