Heartland Chevelle Club Membership Application Name: ___________________________________________________________ Street Address: ___________________________________________________ City: ____________________________ State: ________ Zip: ____________ Phone: __________________________________________________________ Email: ___________________________________________________________ Chevelles Currently Owned: ____________________________________________ Other Club Affliations: ______________________________________________ Spouses Name: ___________________________________________________
Dues shall be Thirty Dollars ($30.00 U.S.) per year. The first year's dues will be prorated at the rate of $2.50 per month for the number of calendar months remaining from the date the membership begins to the end of that year. PLEASE MAKE CHECKS PAYABLE TO: Heartland Chevelle Club The club's website is http://heartlandchevelles.net Please send the application to: Heartland Chevelle Club Additional Contact Information for Jan, HCC Secretary: Phone: 402-680-2517.
Please feel free to print this web page, or alternately, this link will provide a WORD document for your use. ( HCC application )
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