Club dues are: $25 per year for primary member (renewal date: April 15th). Immediate family members residing at your address: $5 (This is optional; benefits: Chapter voting/ join Board/ enter badge lottery/ share newsletter). Pro-rated dues: October 15th - April 15th: $12.50 for primary member/$2.50 immediate family member. Canada/Mexico members add: $5 for postage. All other foreign countries add: $10 for postage.

Date: _________________

Name: ____________________________________________________________________

Spouse/family member: ______________________________________________________

Address: __________________________________________________________________

City: _______________________________ State: _______ Zip: ____________- ________

Home phone: (_____) _________________ Work phone: (_____) ____________________

Total U.S. Funds enclosed: _______________

Member of Bow Tie Chevy Association? _________ Member Number? ___________

Member of Classic Chevy International? _________ Member Number? ____________

Classic 1955-1956-1957 Chevrolets owned (with brief description of each)

1) _________________________________________________________________

2) _________________________________________________________________

3) _________________________________________________________________