Membership Application - New and Renewal

DACC Dues are $20.00 per year

Print this form, Fill it in, and mail it with your check or money order, payable to Detroit Area Corvair Club to:

Ken Heberling - DACC
426 W. Hudson
Royal Oak, MI  48067-3122
E-Mail

Name ________________________________        Home Phone ________________________

Address ______________________________        Cell Phone _________________________

City, State, Zip _________________________________________________________________

Email address __________________________________________________________________

Other club affiliations ___________________________________________________________

Your Corvairs
Number of Corvairs presently owned? ____________

Year Model Body Style Condition
       
       
       
       
       
Year Model Body Style Condition
       
       
       
       
       

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