POCONO MOUNTAINS CORVETTE
CLUB,INC

Join Our Club


Annual dues are - $50.00 From January 1 to December 31
                             $25.00  After July 1 to December 31




Please Print print out thE application, fill it out completely and mail with a check to:

POCONO MOUNTAINS CORVETTE CLUB
P.O. BOX 1014
MILFORD, PA. 18337


Date: _______________


Name:_________________________________________________

            Birthdate: Month___________Day:____________


Spouse/Significant other: __________________________________

            Birthdate: Month___________Day:____________

Address: _______________________________________________

_______________________________________________________

Phone Number: __________________________________________
Business Phone:__________________________________________
Cell Phone:______________________________________________
Cell Phone:______________________________________________

E-Maill Address: __________________________________________________

Year and Color of Corvette(s) ________________________________________

________________________________________________________________


QUESTIONS - pmcc@poconomountainscorvetteclubinc.com

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