Membership Application - New and Renewal

DACC Dues are $15.00 per year for both new members and renewals.

Print this form, Fill it in, and mail it with your check to

Detroit Area Corvair Club
Clark Hartzel
16911 Anita
Frazer, MI 48026
E-Mail Clark

Name ________________________________        Home Phone ________________________

Address ______________________________        Work Phone _________________________

City _________________________________        Work Phone _________________________

City, State, Zip ________________________________________________________________

Other club affliations ___________________________________________________________

Your Corvairs
Number of Corvairs presently owned? ____________

Year Model BodyStyle Condition
       
       
       
       
       
Year Model BodyStyle Condition
       
       
       
       
       

General Interest (Check all that apply)

  Early Models (60-64)
  Late Models (65-69)
  Forward Control
  Stock
  Modified
  80 - 100 HP
  102-140 HP
  Turbo
  Daily Street Use
  Rallying
  Show-Concours
  Parades
  Restoration
  Drag Racing
  Road Racing
  Model Cars
   
   

Would you be willing to serve in an offical capacity or as a board member? ____________ (yes,No,Possibly)