Northwest Classic Chevy Club 2012
Membership Application

Tell us about yourself!
Full Name
Address
City State Zip
Phone (cell) Phone (home)
Email

What classic Chevy do you drive (or are working on)?
Year Model Color

What work have you done to your car? Stock or modified?
 

 

Engine & drivetrain information
 

 
If you have photos or want them published on the roster please send them to davidcwhite@comcast.net

Club dues are $25.00 per year (Jan 1 - Dec 31) / Prorated (July to Dec) $12.50

Return this completed form along with your payment to:

NWCCC Dues
c/o Mark Wadzinski
13188 SE Newport Way M-201
Bellevue, WA 98006

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Signature Date