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If you are interested in becoming a member, please print this page and mail it along with a check made payable to "REBEL Corvettes of the Bluegrass" to the following address: Juanita Augustson 524 Hiawatha Trail Frankfort, Ky. 40601 |
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Membership: New ( ) Old ( )
Dues: Member-$25/year Spouse- $15/year
Member Information
Name______________________________________ Date of
Birth_____/______/____
Spouse_____________________________________ Date of
Birth_____/______/______
Street______________________________________________________________________
City_____________________
Phone: Home (______)_____________
Year of Corvette_______ Body Style_____________ Color____________
Sponsored by___________________________________________
Hobbies, or other interest_______________________________________________________________
_____________________________________________________________________________________
EMAIL ______________________________@______________________________Signature_________________________ Date____/_____/______