Northern Ohio Chevelle Club Membership Application
Your First Name *
Your Last Name *
Street Address *
Apt or Suite
City *
State *
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code *
Home Phone *
Cell Phone or Other
Email Address *
Your Birthday
Spouses First Name
Spouses Birthday
Do You Currently Own A Chevelle? *
Not Yet
Yes
Model Year
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
Model
Sprint
Beaumont SD
Beaumont
El Camino SS
El Camino
Malibu SS
Malibu
Chevelle SS
Chevelle
Wagon
Other
Engine
Other
502
454
427
402
400
396
383
350
327
307
283
Engine Info
Transmission
Other
5spd
M22
M21
M20
4L60
700R4
Powerglide
TH400
TH350
Transmission Info
Car Color
Tell us about your car
A link to a picture of your car
Tell Us a Funny or Interesting Car Story
What Is Your Dream Car
How Did You Hear About Our Club
Are You a Member of ACES *
Yes
No
Are You a Member of TeamChevelle *
Yes
No
Do You Have a Facebook Account *
Yes
No
List Any Other Car Clubs You Belong To
What Is Your Favorite CruiseIn
Type the following:
For security purposes, please type the letters in the image.