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New Member Registration Form
*
Indicates required field
Primary Member Name
*
First
Last
Enter your first and last names
Month/Day of birth (optional)
*
Enter your birthday in MM/DD format. Year is not required
Name as it should appear on club name tag
*
Enter your as you would like it to appear on your club name tag
Secondary Member Name
*
First
Last
Enter the first and last names of secondary member
Month/Day of birth (optional)
*
Enter secondary member's birthday in MM/DD format. Year is not required
Name as it should appear on club name tag
*
Secondary Membership Type (Select One if applicable)
*
Spouse/Companion (see below)**
Dependent Member aged 16-21 (see below)**
Club Dues
(please select all applicable)
If joining October – May = $45 per year with a one-time $10 initial fee for a total of $55.
If joining June – September, $25 for the balance of the year with a one-time $10 initial Fee for a total of $35.
If also registering a Secondary Member, dues are an additional $10
Annual renewals in October will be $45 for primary, $10 for Secondary
Please Select One
*
New Primary Member (joining Oct-May): $55
New Primary Member (joining Jun-Sept): $35
Select dues based upon month you are joining
Specify if including Spouse/Companion/Dependent Member
*
New Secondary Member: +$10 (see below) **
No Secondary Member
Mailing Address
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Line 1
Line 2
City
State
Zip Code
Country
Enter your mailing address for club correspondence
Primary Member Home Phone
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Primary Member Cell Phone
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Secondary Member Cell Phone
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Primary Member Email
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Secondary Member Email
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Corvette #1 Year
*
Color
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Model
*
Corvette #2 Year
*
Color
*
Model
*
How did you find out about Adirondack Corvettes
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Activity or Event you would like to see as a part of our schedule of events:
*
**Note: Adirondack Corvette Club, Inc. (ACCI) membership is not required for a spouse/companion/dependent, but is highly recommended and encouraged if the spouse/companion/dependent may be participating in club activities to ensure liability insurance coverage at official club events.
Click the
Print Form
button below to print a copy of this form.
Send the printed form along with a check for the applicable dues payable to
Adirondack Corvette Club, Inc.
and mail it to:
Adirondack Corvette Club Inc.
PO BOX 716
Glens Falls, NY 12801
Thank you!
PRINT FORM
To also submit your Membership Application online without payment, click the Submit Form Button below.
You will still need to mail in the printed version along with your check for the applicable dues to the address above.
Submit Form
