Mason Dixon Corvette Club
PO Box 68 Pleasant Hall, PA 17246
Phone: 717-532-8433
http://www.innernet.net/mdcc

The Mason Dixon Corvette Club was organized in 1973 to provide legal and safe activities to which Corvette owners could devote their time, effort and love.   The activities of the club include road rallies, Corvette shows, Parades, and social events.  MDCC publishes a monthly newsletter.   The regular monthly meetings are held the second Monday of each month at 7:30 p.m. at a designated place decided upon at the previous meeting.  Membership is open to anyone interested in the Clubs activities, either participating, or working with our fine organization. The only stipulation is you must own a Corvette to become a member.

MEMBERSHIP APPLICATION

Name___________________________________________________________________ Birth Date_____________

Spouse/Significant Other____________________________________________________Birth Date_____________

Address_____________________________________________________________________________

City____________________________State__________Zip_________

Children (Under 18) _____________________Name/Date of Birth ____________________________

Home Phone:(______)________-___________ Email __________________________________

Business Phone (______)_______-_________ Other/Cell (______)______-__________ Fax (_____)_____-_____________

***Do you want your address and/or phone information distributed to the club membership?***
Please check off information that will be listed: Phone Only ____: Address Only ____: Neither _____: List All _______

Occupation/Employer __________________________________________________________________________

Sponsored By __________________________________________________________________________________

Corvette(s):
Year-- Color-- Coupe/Conv.Hardtop-- License Plate#

____________________________________________________________________________________________

____________________________________________________________________________________________

Applicant Signature ______________________________Co-Applicant Signature ____________________________
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New Members: 1^st Year membership dues are $25.00 plus $5.00 initiation fee = $30.00
If you join: June 1st through September 30^th = $12.50 plus $5.00 initiation fee = $17.50
If you join: Oct 1st through Dec 31st = $6.25 plus $25.00 (for the next years Dues) plus $5.00 initiation fee = $36.25
(New members will receive a free MDCC window cling-on)      
Membership Renewal: Annual Membership January 1st through December 31^st = $25.00 (per year)

Total Enclosed: $ _______________ Print this Application and mail to Club Address with check.