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