Permian Basin Corvette Club

Membership Application

Name:

_____________________________________________

DOB _____________

Address:

_____________________________________________

 

City, State, Zip

_____________________________________________

Phone:

HM: ________________________Cell:________________________

 

Email

_____________________________________________

 

Spouse

_____________________________________________

DOB _____________

Spouse Email:

 _____________________________________________

Spouse Phone:

_____________________________________________

Corvette(s)

_____________________________________________

 

 

 

Your email address(es) will be added to our club email distribution lists automatically.  We have 2 lists – one for events related emails and one for general emails.  We encourage you to be on the “events” email list so you can keep up with events.  At the bottom of each email is a button to “unsubscribe” from the list if you choose to do so.

 

Unless you indicate otherwise, the above information will be included on the club membership list.

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