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Member Name and Birthday Month and Day*

Co-Member Name and Birthday Month and Day

Street Address*

City, State And Zip Code*

Email Address*

Co-Member Email Address

Home Telephone Number

Member and Co-Member Cell Phone Numbers*

Corvette Year, Color, License, Model and Insurance Carrier*

Second Corvette Year, Color, License, Model

Emergency Contact and Phone Number And Relationship*

By checking this bubble, I Agree To Rancho Murieta Corvette Liability Release Rules* I hereby release and agree to hold all participants of the Rancho Murieta Corvettes harmless from and waive on behalf of myself, my heirs, and all personal representatives from any and all causes of action, claims, demands, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by all acts, or failure to act of any participant of the said club, or that may otherwise arise in all ways in connection with any actvity or event organized by Rancho Murieta Corvettes participant. I understand that this release discharges all participants of any said club activity from any liability or claim that I, my heirs, or all personal representatives may have against all participants in any event with respect to bodily injury, all illnesses, death, medical treatment, or property damage that may arise from, or in connection to, all services recieved from any participant of any Rancho Murieta Corvettes activity. This liability waiver and release extends to all paticipants. Rancho Murieta Corvettes strictly prohibits racing on public streets or unauthorized tracks and I agree to operate any of my vehicles during any Group event in a safe and lawful manner pursuant to state and local laws as well as Group Rules Of The Road found on the website. By selecting the appropriate circle, below, I certify that my vehicle used in any and all Group events is properly registered and insured to meet legal requriements of liability in all locations an event is being held according to current laws.

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Please Fill In This Form To Join The Rancho Murieta Corvettes

Annual dues are $40 and payable to the club treasurer. Please mail or drop off your check to:

Rancho Murieta Corvettes

c/o Kent Kilborn

14933 Trinidad Drive

Rancho Murieta, Ca, 95683