New Member Application Form "*" indicates required fields Security Information: Your Application Information is safely transmitted with encryption automatically All personal information will be excluded from the Club’s Membership Directory with the exception of your name, email address, vehicle(s) listed, and membership term end date. The Membership Directory is posted to the Members Only page on the website and will not be shared outside of VCC Membership The On-Line Dues Transaction is conducted by PayPal, a Nationwide OnLine Secure payment system PayPal accepts payment from PayPal account holders or ANY major credit card You DO NOT NEED A PAYPAL account … you can use your credit card The VCC club and/or its Treasurer DOES NOT HAVE access to your credit card information You will receive a receipt email from PayPal and a confirmation email from the VCC Application is for New Members and Associate Members only:*Select one1 Year Membership for Member ($35.00)1 Year Membership for Member & Associate ($55.00)2 Year Membership for Member ($65.00) – ($5 savings)2 Year Membership for Member & Associate ($100.00) – ($10 savings)3 Year Membership for Member ($95.00) – ($10 savings)3 Year Membership for Member & Associate ($145.00) – ($20 savings)(Associate Member must reside in the same household of the VCC member and term chosen by the Member shall apply to the Associate Member without deviation.) CONTACT INFORMATION MEMBER Member Name* First Last Member Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Member Email* Member Home Phone*Member Cell Phone* ASSOCIATE MEMBER (must reside in the same household as the VCC Member ) Associate Member Name* First Last Associate Member Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Associate Member Email* Associate Member Home Phone*Associate Member Cell Phone* VEHICLE INFORMATION (optional) Vehicle #1 Make: Vehicle #1 Model: Vehicle #1 Year: Vehicle #2 Make: Vehicle #2 Model: Vehicle #2 Year: Vehicle #3 Make: Vehicle #3 Model: Vehicle #3 Year: Agree to Terms* I agree to the following terms:I submit this completed form for membership with the understanding that there is no refund regardless of paid membership term. I understand that all personal information will be excluded from the Club’s Membership Directory with the exception of my name, email address, listed vehicle(s), and membership term end date. I understand the Membership Directory posted on the Members Only page on the website requires a password for access and will not share the password or directory outside of VCC Membership. As a Member/Associate, I authorize release of my name or any photos taken of me or my car during a VCC sponsored activity that may be posted to the VCC Website or the VCC Facebook page. Total Dues: Finish and Proceed to PayPal.Click the SUBMIT button below to proceed to Paypal to pay the dues. Once you have paid via PayPal or your Credit Card you will automatically become a member of the VCC. Section BreakSection BreakPhoneThis field is for validation purposes and should be left unchanged.
