Chesapeake Classic Car Club

Membership Application

Date ____________________Individual($10)____  Family($15) ____  Dues are due July 1 each year

Please update our records and/or changes below. Also indicate birthdays and anniversary so we may recognize it in the newsletter.

Name(s)__________________________________________________________________________

Birthday________________ Spouses birthday_______________ Anniversary________________

Address__________________________________________________________________________

City_______________________________________ State__________________ Zip____________

Phone _________________________________________ _ Fax _____________________________

Email_________________________________________________ for newsletter and event contact

Car Make________________________ Model_________________________ Year_____________

Mail form and check payable to CCCC to:        CCCC, P.O. Box 2233, Easton. Maryland 21601