APPLICATION FOR MEMBERSHIP FORM

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=100 BGCOLOR="#000000" TEXT="#F7F7FF" bgproperties="fixed" background="04a00640dvldtc.gif"> <div> <FONT SIZE="5" COLOR="#FFCC66" FACE="Arial" ><B>Mid-Hudson Valley Corvette Association</B></FONT><B>     |     </B><A HREF="index.htm" TARGET="_top" TITLE="MidHudson Valley Corvette Association"><U><B>home</B></U></A></div> <div> <B>APPLICATION FOR MEMBERSHIP FORM</B></div> <div> </div> </td> </tr><tr> <td valign="top" width=210 BGCOLOR="#000000" TEXT="#F7F7FF" background="04bd2c00dvldtc.gif"> <div> <A HREF="id19.htm" TARGET="_top" TITLE="Contact Us"><U>CLICK HERE TO RETURN </U></A></div> <div> <A HREF="id19.htm" TARGET="_top" TITLE="Contact Us"><U>TO </U></A><FONT SIZE="2" COLOR="#FFFF33" FACE="Arial" ><A HREF="id19.htm" TARGET="_top" TITLE="Contact Us"><U><B>CONTACT US</B></U></A></FONT><A HREF="id19.htm" TARGET="_top" TITLE="Contact Us"><U> PAGE</U></A></div> <div> <A HREF="id19.htm" TARGET="_top" TITLE="Contact Us"><U><IMG SRC="0a3422b0.jpg" border=0 width="66" height="43" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></U></A></div> <bR> <bR> <bR> <div> <A HREF="index.htm" TARGET="_top" TITLE="MidHudson Valley Corvette Association"><U>CLICK on FLAGS to</U></A></div> <div> <A HREF="index.htm" TARGET="_top" TITLE="MidHudson Valley Corvette Association"><U>RETURN to HOME PAGE</U></A></div> <div> <A HREF="index.htm" TARGET="_top" TITLE="MidHudson Valley Corvette Association"><U><IMG SRC="09a83360.jpg" border=0 width="131" height="54" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></U></A></div> </td> <td valign="top" height=380 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> APPLICATION FOR MEMBERSHIP FORM</div> <div> <B>Mid Hudson Valley Corvette Association</B></div> <div> <B>c/o William Way, 15 Tiffany Lane, Wallkill, NY  12589</B></div> <bR> <div> <B>Date</B><FONT SIZE="3" COLOR="#111111" FACE="ChelthmITC Bk BT" >_______________</FONT></div> <bR> <div> <B>Name ______________________________________________________ </B></div> <bR> <div> <B>Spouse's Name ______________________________________________</B></div> <bR> <div> <B>Address ____________________________________________________</B></div> <bR> <div> <B>City ________________________________________________________ </B></div> <bR> <div> <B>State _____________________________ Zip ______________________</B></div> <bR> <div> <B>Home Phone Number ________________________________________</B></div> <bR> <div> <B>Cell Phone Number _________________________________________</B></div> <bR> <div> <B>Spouse's Cell Phone Number _________________________________</B></div> <bR> <div> <B>E-mail Address ______________________________________________</B></div> <bR> <div> <B>Automobile Information</B><FONT SIZE="2" COLOR="#111111" FACE="ChelthmITC Bk BT" ><B> </B></FONT></div> <div> <B>(Please note that some members are Dodge Viper and Prowler Owners</B></div> <div> <B> -- Other exotic car owners are also welcome)</B></div> <bR> <div> <B>Year of Corvette/Auto</B><B> ____________   </B><B>Style _________________  </B></div> <div> <B>Color _______________</B></div> <bR> <div> <B>Year of 2nd Corvette/Auto </B><B>____________   Style _________________  </B></div> <div> <B>Color _______________</B></div> <bR> <div> <B>$55.00 Yearly Fee (Oct. 1 to Sept. 30) </B></div> <bR> <bR> </td> </tr></table></body>