Membership Application - New and Renewal

DACC Dues are $20.00 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
Fraser, 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? ____________

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