Membership Application - Lake County Community Corvette Club

Please provide your personal details as part of the membership application process.

Name *

Date of Birth *//

Address *

City *

State *

Zipcode *

Phone *

Email *

Please provide information about your Corvette.

Make *

Model *

Year *

Color *

License Plate Number *

State Issued *

Indicate the type of membership for which you are applying.

Are you a Veteran *

Reason for joining *

How did you find us? *

Who recommended you? *

By signing below, you agree to follow the club rules and understand that membership and other applicable fees will apply.

Upload Picture *

Date *

Emergency Contact Name *

Address *

Phone *

Please upload a picture of your car *

Lake County Community Corvette Club

President Rodney Turner

Email: info@lcccorvetteclub.org