Heartland Chevelle Club

Membership Application

Name: ___________________________________________________________

Street Address: ___________________________________________________

City: ____________________________ State: ________ Zip: ____________

Phone: __________________________________________________________

Email: ___________________________________________________________

Chevelles Owned: _________________________________________________

Other Club Affliations: ______________________________________________

Spouses Name: ___________________________________________________

Dues shall be Twenty-four Dollars ($24.00 U.S.) per year. The first year's dues will be prorated at the rate of $2.00 per month for the number of months from the date of membership to the end of that year.

The club's website is http://heartland.chevelles.net

Please send the application to:

Bob Von Kaenel (club president)
7850 Lexington Ave.
Lincoln, NE 68505
402-465-4356