The document is a membership renewal form for the Pacific Coast Corvette Club. It states that annual dues are $30 per household and must be renewed by March 1, 2010 or the member's name will be removed from the membership list. It requests information such as name, address, contact details, birthdays, and Corvette details. Members agree to abide by the club's constitution and bylaws.

1. MAIL TO: Pacific Coast Corvette Club
PO Box 14
Coos Bay OR 97420
MEMBERSHIP RENEWAL
Dues are $30 per year per household (couple)
Renewals are due by March 1, 2010 or your name will be omitted from the membership list.
I/We hereby renew my/our membership in the Pacific Coast Corvette Club in the classification indicated
above. I/We agree to abide by the Constitution and Bylaws of the Club and regulations governing its
operation as adopted by the membership.
NAME: ______________________________________________________________Birthday & Month _________________
ADDRESS: ____________________________________________CITY: ________________ ZIPCODE _________________
SPOUSE/OTHER: ___________________________________________________ Birthday & Month ______________________
HOME PHONE: ___________________________FAX: ___________________________CELL: ________________________
BUSINESS PHONE: ____________________________________ (
EMAIL ADDRESS: _____________________________________________________
Do you want your phone number to be published for others to see? YES __________ NO _____________
CORVETTE INFORMATION
MODEL: _______________________________COLOR: _______________________ YEAR: _________________
SPECIAL FEATURES: __________________________________________________________________________
MODEL: _______________________________COLOR: ________________________YEAR: ________________
SPECIAL FEATURES: _________________________________________________________________________
SIGNATURE OF APPLICANT ____________________________________________________________________
Please return this form and your check to the address above. Thank you.