ICCC SENIOR MEMBER DUES WAIVER APPLICATION

ICCC Senior Member Dues Waiver Application
Guidelines for paying the membership due of a member at age 75 for the year 2025, the member will need to do the following:
- You will need to provide the membership committee a copy of a document(s)* that has a picture ID , your address and birthday on it
You will be recognized during the Annual ICCC Convention
1. ICCC MEMBER INFORMATION
Full Name*

First Last
ICCC Member #
Phone Number*

Area CodePhone Number
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
2. VERIFICATION
Have you been a financial ICCC Member for the past 10 consecutive years to qualify for the Senior Members Dues Waiver?*

YesNo
Beginning Date of Consecutive ICCC Membership*

MonthDayYear
Ending Date of Consecutive ICCC Membership*

MonthDayYear
VERIFICATION PAPERWORK

Provide the membership committee a copy of a document(s)* that has a picture ID , your address and birthday listed.
Upload a File

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By clicking the submit button below, I cerity that all of the information provided by me on this ICCC Senior Member Dues Waiver Application to the International Council of Corvette Clubs (ICCC) is true and complete, and I understand that if any false information, ommissions, or misrepresentations are discovered, my application will be rejected.

I also understand and agree that the terms and conditions of this charitable donation request application may be changed, with or without cause, and with or without notice, at any time by ICCC.
Electronic Signature*

First NameLast Name
Enter the message as it's shown*
Date*

MonthDayYear
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ICCC Senior Member Dues Waiver Application

1. ICCC MEMBER INFORMATION

2. VERIFICATION