Permian Basin Corvette Club

Membership Application

Name:

__________________________________________

DOB _____________

Address:

__________________________________________

 

Phone:

__________________________________________

 

Email

__________________________________________

 

Spouse

__________________________________________

DOB _____________

Corvette(s)

__________________________________________

 

 

 

Special Interests (circle as many as you like)

 

Car Shows

 

Weekend Road Trips

Poker Runs

 

Charity Benefits

One-Day Road Trips

 

Other __________________________

WAIVER: I/We, the above listed person(s), hereby agree to waive any and all actions, claims, demands, obligations, and/or causes of action against the Permian Basin Corvette Club (Club), its members, officers and representatives stemming from membership in the Club and/or participation in any events sponsored by or relating to the Club and to hold harmless the Club, its members, officers and representatives.

 

I further agree to indemnify the Club against the claims of any passengers, spectators or non-member guests in Club sponsored or related activities whom I have invited or caused to participate in said activities.

 

 

 

_________________________________________               _________________________________________

                        Signature                                                                                    Signature

 

Proof of automobile insurance is required. I hereby state the insurance on my vehicle(s) participating in PBCC events is in force.

 

_________________________________________

              Signature       

 

Dues are $25.00 per year per family.

If you join after October 1, your dues will cover you for the rest of the calendar year and the next calendar year.

Annual dues are due at the first meeting of the calendar year.  Dues are not prorated.

 

Please print this application and mail application with check payable to PBCC to:

 

PBCC

PO Box 60394

Midland, TX  79711-0394

 

You will receive an email or letter (if email address not provided) to notify you that your application has been processed and accepted.

 

For additional Club information please visit www.permianbasinvettes.com