Leatherstocking                                      Member

Corvette Club                                          Information

PERSONAL INFORMATION

Name:  Last                                                First                                  MI

Date of Birth:

Address:                                                      City:                          Zip:

Home Phone:                           Wk:                          Cell:

EMail Address:

Spouse Name:                                                      Date of Birth:

EMERGENCY CONTACT

Emergency contact:                                             Phone:

Emergency contact address:

CORVETTE INFORMATION

Year:                                                        Color:

Body Style:

Year:                                                         Color:

Body Style:

CLUB INTERESTS

Cruises:

Car Shows:

Autocross:

Charity Support/Organization:

Planning - Trips/Events:

Additional Info:

Signature of Applicant:                                                       Date:

 Come be a member of our Leatherstocking Corvette Club!  LCC members come from the Norwich, Cooperstown and Oneonta areas. A  years membership is $20.00 single and $30.00 couple/significant other.  The clubs new year begins October 1, each year.  Complete the application available on our Web Site and forward it to one of the LCC Officers (email or mail it to one of the following Members).  Come enjoy your Corvette with us by participating in Cruises, Car Shows, Winery Tour and much more!

Dick Fleming, President (rfleming80@msn.com) 5642 County RD 32  Norwich NY 13815 607-334-6969

Sharon Fleming, Secretary (rfleming80@msn.com) 5642 County Rd 32   Norwich, NY 13815 607-334- 6969