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 2024, 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 2024 Annual Convention
ICCC Member Information
Full Name*

First Middle Last
ICCC Member #*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
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
Upload a File

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Send Application:
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 NameMiddle NameLast Name
Enter the message as it's shown*
Date

MonthDayYear
Should be Empty:

ICCC Member Information

Verification

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