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Membership Application
□ New Membership □ Renewal Membership
□ Lifetime Membership □ Honorary Membership
Annual dues are $40
Renewal, Lifetime and Honorary memberships expire if not renewed by Dec. 31.
New membership dues pro-rated as follows:
$40 if paid in Jan – June; $30 if paid in July – Sept;
$15 if paid in Oct – Dec
Name 1:
Name 2:
Birthday 1 (MM/DD):
Birthday 2 (MM/DD):
Email 1 (optional):
Email 2 (optional):
Home Phone 1:
Home Phone 2 (optional):
Cell Phone 1 (optional):
Cell Phone 2 (optional):
Address:
City: ________________________________ State: _______ Zip:
Newsletter Delivery Method: ____ Email only
Mail only
Both Email & Mail
Corvettes (year, color & style)
I agree to hold harmless Classic Corvettes of Minnesota, its officers, directors, agents, employees for any acts of or
omissions which may result in theft, damage, or destruction of my property or injury to me or others occurring as a
consequence of this club’s sanctioned events but not limited to car shows, cruises, tech sessions, or other events
wherever located. I have proof of insurance that at least satisfies Minnesota’s minimum auto and liability insurance
requirements for my vehicle and property. I have insurance for my vehicle and property for loss, damage, and liability. I
can provide such proof if asked to do so.
Signature 1: ______________________________________________ Date: ______________
Signature 2: ________________________________________Date: ____________
Membership dues include you and your spouse/significant other. Send the signed form along with a check
made payable to Classic Corvettes of Minnesota and mail to: Classic Corvettes of Minnesota, PO Box 11865,
Saint Paul MN 55111-0865.