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