Mohawk Valley
Corvette Club, Inc.
Membership Application

Please print this page, fill it out clearly
and send it along with your check or money order for $25 to:

The Mohawk Valley Corvette Club
P.O. Box 325
New Hartford, New York 13413


Name:_______________________________________________________________________________

Spouse or Significant other:______________________________________________________________

Address:______________________________________________________________________________

Home Phone:___________________________Cellular:________________________________________

City:______________________________________________________________Zip:________________

Email:________________________________________________________________________________

Sponsored by:__________________________________________________________________________

Corvette Year:__________________Color:__________________________Model:__________________

Corvette Year:__________________Color:__________________________Model:__________________

Corvette Year:__________________Color:__________________________Model:__________________