Date: __________________

PLEASE PRINT

Applicant Type: Primary ‰ Associate ‰ Enthusiast (Select one; see definitions on back of form)

Color _______________ Special features ______________________________________________________________

Have you ever been a member of NCCC? IF YES, Name of Club: ____________________________________________________________

Reason for joining CCI: __________________________________________________________________________________________________

Memberships in other clubs: _______________________________________ Offices Held: _________________________________________

Special interests/ skills: __________________________________________________________________________________________________

Annual Dues must accompany completed application (Checks payable to "Corvette Club of Iowa")

Applicant Youth

$ 65.50* $16.50 $ ______

$ 55.50* $16.50 $ ______

New Member or Renewal after November 1:

Renewal prior to November 1st:

Treasurer, Corvette Club of Iowa Lifetime NCCC Member

812 Westwood Drive (One-time Charge; if current member ($300)

Nevada, Iowa 50201

Internal use only

Primary's NCCC # ____________________ Spouse/Companion's NCCC # ____________________ Youth NCCC # ___________________

NCCC issued check #: _______ Date checked mailed to RMD: _______ RMD's Initials: ________________ RMD Date: ____________

Date application received: __________ Club Treasurer's initials: _______ These dues are for the year __________________________

*The annual primary dues for NCCC membership includes a yearly subscription to NCCC's Blue Bars publication.

$335.00

$20.50

Spouse/Companion

$20.50

Corvette Information: Year ____________ Coupe Convertible Fixed Roof Grand Sport Z06 ZR1 ( Check One)

Youth (if joining): _____________________________________________________________ M F DOB: ______________________

Primary Home Phone #: _________________ Cell Phone #: ___________________ Email: ________________________

Spouse/Companion Home Phone #: _________________ Cell Phone #: ___________________ Email: ________________________ ___

Spouse/Companion Address: _____________________________ ______________________ ____________________ ______________

Spouse/Companion (if joining):__________________________________________________ M F DOB: _____________________ member whose mailing address is the same as the Primary Member may become a member of CCI upon payment of all CCI, West Region, and NCCC dues and fees. The member shall be entitled to all privileges of Primary membership If different from Primary: Street Address: _______________________________ State:____ Zip Code: _____-_____

Applicant Name:__________________________________________________________________ M F DOB: ___________

State

Primary's Address: _________________________________________ ______________________ ____________________ ___________

Applicant referred by: _____________________________________________

Blue Bars (NCCC magazine): Hard Copy Online

Corvette Club of IowaAN AFFILIATE OF THE

National Council of Corvette ClubsPROMOTING SAFE DRIVING SPORTSMANSHIP COMMUNITY RELATIONS

MEMBERSHIP APPLICATION

(Select One)

New Member

Member Renewal

Primary NCCC #: ____________________________________________________________________ Date: _____________________________

Spouse/Companion NCCC #: _________________________________________ Youth NCCC #: _______________________________________

Signature certifies that I am at least 19 years of age.Primary Signature: ___________________________________________________________________ Date: ____________________________

Address City ZIP Code

StateCityCity ZIP CodeAddress

Mail Completed Application to:

Revised March 2021

Primary Member: Owner or operator of a Chevrolet Corvette. Must be at least 18 years of age.

Associate Member:A former Corvette Club of Iowa (CCI) member who does not currently own a Corvette. Holders of this membershiptype may not hold an elected CCI office or compete for West Regional or NCCC points. Dues and fees are equal to those of a Primary member.

Enthusiast Member: Holders of this membership type do not currently own or operate a Chevrolet Corvette, nor are they former membersof CCI. They simply enjoy the Corvette and the people who own and operate them. Holders of this type of membership have no voting rights, cannot hold any offices in the organization, and cannot compete for any club, regional, or national points. Dues and fees are equal to those of a Primary member.

Spouse/Companion Member: The Spouse/ Companion of any Primary member whose mailing address is the same as the Primary Member may become a member of CCI upon payment of all CCI, West Region, and NCCC dues and fees. The member shall be entitled to all privileges of Primary membership.

Youth Member:

A person sponsored by a Primary Member who is between the ages of 16 and 21 years of age, or a full time student between the ages of 16 and 25 years of age, whose mailing address is the same as the Primary Member shall become a

member of CCI upon payment of all membership dues and fees. They shall be entitled to all rights and privileges of the

Spouse/Companion membership, except the right to hold an elected CCI office and they may not “chair” a sanctioned

or unsanctioned event.Revised March 2021