Join G.A.C.C.

	Gateway Area Chevelle Club Membership Registration Annual dues are $30. Fill out the form and submit now, then drop your check for first years dues in the mail tomorrow.

PERSONAL INFORMATION:

* = Required

Name:

(Primary Member) *

Spouse/other:

(Families are included)

Address:

(Required to receive newsletter) *

, *

Phone:

e-mail:

Personal web site:

CAR INFORMATION: (if more than one car, please submit additional forms)

Year:

Model:

V.I.N.:

(Optional)

Category (check one)

Original

Restored Original

Restored Modified

Street Rod

Daily Driver

Engine(CI):HP: Transmission:

Options (check all that apply) PS PB A/C PW Tilt

Please specify other significant details:

OPTIONAL INFORMATION:

How long have you owned your car?:

Occupation:

Employer:

Work Phone:

Member of:

A.C.E.S.

N.C.O.A.

Other:

Other cars,
hobbies, etc.:

Are you able to assist with the operation of the club:

If so, please state a best time and number to contact you:

Thanks!

or
Print and mail to:

Gateway Area Chevelle Club, Inc.
Attn: Membership
PO BOX 575
Hazelwood, MO 63042