Date______________ Name_________________________________ Birth Date______________ Spouse_______________________________ Birth Date______________ Permanent Address_______________________ Home Phone_________ Mailing Address___________________________ Work Phone_________ City___________________ State________________ Zip Code_________ Type of Corvette Year Corvette_________ Body Style____________ Color____________ Year Corvette_________ Body Style____________ Color____________ Year Corvette_________ Body Style____________ Color____________ Year Corvette_________ Body Style____________ Color____________ I hereby agree, as a condition of my membership in the CEN-TEX CORVETTE CLUB, Waco, Texas, that I am joining this club for my own pleasure and will be fully responsible for my actions at all times. I release the CEN-TEX CORVETTE CLUB, Waco, Texas, of all liability whatsoever, and their assignees, officers, officials, heirs, and all others connected with the club heretofore. Applicant's Signature_________________________ Date____________ President's Signature_________________________ Date____________ Club Use Only Membership Status: Regular______ Honorary______ Visited__________________________
|