Okee Bay Lodi, WI 53555
APPLICATION FOR MEMBERSHIP
NAME_____________________________________________________________
_____________________________________________________________
ADDRESS__________________________________________________________
__________________________________________________________
__________________________________________________________
HOME PHONE______________________________________________________
CELL PHONE_______________________________________________________
E-MAIL____________________________________________________________
YEAR AND DESCRIPTION OF CORVETTE/S:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
I HAVE READ AND UNDERSTAND THAT THE COLUMBIA COUNTY CORVETTE CLUB U.A.
IS AN UNINCORPORATED ASSOCIATION REGISTERED WITH THE STATE OF WISCONSIN.
THE CLUB NOR THE OFFICERS NOR THE MEMBERS ARE LIABLE FOR ME OR MY
ACTIONS. THE CLUB CARRIES NO INSURANCE AND I UNDERSTAND THAT I AM
RESPONSIBLE FOR MY OWN INSURANCE.
SIGNED___________________________________________DATE______________________
NEW MEMBERS - $20 FOR AN INDIVIDUAL MEMBERSHIP AND $25.00 FOR A COUPLE MEMBERSHIP, BRING PAYMENT AND FORM TO THE NEXT EVENT AND GIVE TO A CLUB OFFICER.