Name: Hendrick Chevrolet Corvette Show
Start: 2021-05-02T08:00:00-05:00
End: 2021-05-02T15:00:00-05:00
Location: Hendrick Chevrolet Shawnee Mission

This application will be submitted to the Club Membership Chairperson.

The annual Membership cost for the club (including 2021 membership) is $45 for a primary member and an additional $10 for spouse/significant other(if they choose to join).

You can use PayPal to submit payment at CorvetteClubofKC@gmail.com after submitting this application.

Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Email Address*
Date of Birth*
Cell Phone*
Home Phone
Work Phone
Occupation
Employer
Spouse/Significant Other
Name
Date of Birth
Email Address
Anniversary Date
Cell Phone
Home Phone
Work Phone
Employer
Occupation
Corvettes
Year*
Model*
Color*
Year
Model
Color
Liability Waiver*
I hereby release, discharge and hold harmless the Corvette Club of Kansas City (CCKC), its agents, officials, representatives, volunteers and any organizers, sponsors, participants or anyone else connected with any CCKC event or meeting, from any and all liabilities, known or unknown damages, injuries, illnesses, losses, judgements and/or claims, from any cause whatsoever, that may be suffered by his/her person, property or guests participating in any CCKC event or meeting.
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Corvette Club of Kansas City

Club Membership Application

Spouse/Significant Other

Corvettes

Sponsored by Hendrick Chevrolet Shawnee Mission