www.steeltownvette.com
Steel Town Corvettes Membership Application
(Instructions: Print page or
open link,
complete form, mail with check to STCC)
Application
Dues: $25 per year (singles,
spouse, friend or relative).
Make checks payable to Steel Town Corvettes, Inc. or STCC
Please complete ALL questions and mail application and check to:
Steel Town Corvettes
C/O Jerry Tregembo
103 Whitehall Road
Daisytown, PA 15427
________________________________________________________________________
Application For Membership
Date: _________________________________ New Membership _____ Renewal _____
Name: ________________________________ Date of Birth (Month/Day) : _______/_______
Phone (work): ___________________________ Phone (mobile): _____________________________
Spouse/Sig Other: ______________________ Date of Birth (Month/Day) : _______/_______
Phone (work): ___________________________ Phone (mobile): ______________________________
Address: ___________________________ City, State, Zip: _____________________________
Phone (home): ___________________________ Fax: ______________________________
E-Mail address: ______________________________________________________________________
Wedding Date Anniversary (Day and Month) :______________/________________
Corvette(s) owned:
Year: _____________ Model: ___________________ Color: _____________
Year: _____________ Model: ___________________ Color: _____________
Year: _____________ Model: ___________________ Color: _____________
Would you be willing to work on club projects? Y__ N___ Which Projects_____________________
STCC member sponsoring you for membership:___________________________________________
Your main reason for joining the STCC:__________________________________________________