APPLICATION
Steve Hart, President
445 Elm Street
Lincolnton, N.C. 28092
Phone 704-349-1053
.
Carolina Classic Chevy Club
Membership Application
1955 1956 1957 CHEVY’S
Date: ___________________ Paid By: Cash_____
Check____
Name: __________________________________________________________________________
Spouse’s name: __________________________________________________________________________
Address: __________________________________________________________________________
__________________________________________________________________________
Phone #: __________________________________________________________________________
Fax #: __________________________________________________________________________
Email Address: __________________________________________________________________________
Car Information
Year: ___________________________________________________________________________
Make: ___________________________________________________________________________
Model: ___________________________________________________________________________
Color: ___________________________________________________________________________
Other Information about Car
Optional Information:
Anniversary: _______________________________
Birthday: _______________________________
Spouse’s Birthday _______________________________
Club Meetings 2nd Tuesday of each Month
Dues $24.00 per year – due on or before March 1st of each year.
Roger Austin, Vice - President
1538 Union Grove Road
Lenoir, N.C. 28465-7365
Phone 828-728-7377
Sheila Fraley, Treasurer
3529 Stokes Road
Denton, N.C. 27239
Phone 336-859-2350
Cell 704-425-9507