Corvette Club of Utah

  Application Form
*field required for processing
   *Select Membership type below:
 $75.00-New member, full year (Jan 1 - Jun 30) - Includes $35.00 Initiation Fee
 $55.00-New member, half year (Jul 1 - Dec 31) - Includes $35.00 Initiation Fee
 Amended Application
First Name Last Name DOB (mm/dd/yyyy)
*Owner:  
Companion:  
*Address:  
*City:   *State:     *Zip:  
Phone (Home):   (Cell):  
*E-mail:  
*Driver's Licence #:  
*Insurance Company:  
*Policy Number:  
Recruited By:  
Year Color Body Plate
*Corvette #1:  
Corvette #2:  
Corvette #3:  
Please use the space below to tell us a little bit about yourself/selves and your interest in Corvettes. What you tell us will be printed in the Vette Gazette so other members in the club can get to know you.

Please Read Carefully

I/We the undersigned, being of lawful age, do for myself, my heirs, executors, and assignees, hereby release and forever discharge the Corvette Club of Utah, Inc., other participants, and/or individual, group, or corporation, or group of individuals sponsoring the event, his/hers/their heirs, administrators, executors, of and from any and every claim, demand, action, or right of action, of whatsoever kind of nature, either in law or in equity, arising from or by reason of any damage resulting or to result from any accident which may occur as a result of participation in any contest or event sponsored by the Corvette Club of Utah, Inc. The terms of this agreement are contractual and not mere recital. I/We further state that I/We have read the foregoing release and understand the contents thereof, and I/We sign my/our name(s) as my/our own free agent.

*By checking this box you agree to the above.
   
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