Car Club Council of Hampton Roads

Application for Membership/Renewal for year:__________

 

Name of Club ________________________________________________
Club Purpose ________________________________________________
___________________________________________________________
Principal Vehicle Types in Club __________________________________

Club Web Site _______________________________________________
Address _____________________________________________________
City and Zip __________________________________________________
Name of Club President ________________________________________
 Phone (___)_________ Fax _________ E-mail _____________________

Additional information not posted

Number of Club Members  ______________________________________
Amount annually raised for charity ________________________________
Name of Club Delegate to CCCHR _______________________________
Address ____________________________________________________
City and Zip _________________________________________________
Phone _________ Fax _________ E-mail __________________________
 
Name of Alternate to CCCHR ___________________________________ Address ____________________________________________________
City and Zip _________________________________________________
Phone _________ Fax _________ E-mail _________________________


Date of Application ________________________________________
Signed by ___________________________ Club President/Associate

Clubs may join the council by submitting this application and a check for $15 to the CCCHR. Bring application to next CCCHR meeting or email George Smith