ONLINE MEMBERSHIP APPLICATION FORM
ATTENTION! APPLICATION IS FOR   LOCAL APPLICANTS ONLY!
Although we truly appreciate your interest in becoming a member of our club, at this time we cannot accommodate applications for membership outside Connecticut. Although we truly appreciate your interest in becoming a member of our club, at this time we cannot accommodate applications for membership outside Connecticut.

YOUR NAME:
YOUR ADDRESS:
YOUR CITY / STATE / ZIP:
YOUR PRIMARY CONTACT PHONE #:
YOUR DATE OF BIRTH:
YOUR OCCUPATION:
YOUR E-MAIL ADDRESS:

CLASSIC CARS OWNED:
CAR #1 CAR #2 CAR #3

Please check this box if no classic car is owned but you intend to acquire one

Briefly, tell us below why you are interested in becoming a member of the club?

OUR PRIVACY POLICY REGARDING THE INFORMATION YOU ARE PROVIDING:
The information you supply to us from this online application is used solely as an
aid in contacting you and completing the membership application process.
It is in no way or by any means passed along, transferred or sold to any outside
person, agency or representative of any agency. We respect your right to privacy.

Attending/participating in any Classic Nights Car Club (CNCC) event or show implies express permission to the CNCC
to post your image, likeness and/or photograph(s) of your vehicle on our website, and this permission carries over to any media
outlet that may be in attendance. Your attendance/participation also releases and discharges the CNCC and/or anyone else
connected with the representation of the CNCC from any or all known or unknown damages, injuries, losses, judgements and/or
claims that may be suffered by an entrant to his or her person or property. Participants and/or Attendees assume full
responsibility for themselves and their vehicles.