Queen City Chevelle Club
2116 N. Delaware Ave.
Springfield, MO 65803

The Queen City Chevelle Club was formed for the enjoyment and preservation of
1964 thru 1972 Chevelle and El Caminos. Owners of original, restored or
modified Chevelles are invited to join and participate in all activities. Your involvement
in our club is welcomed.

We are a chapter club of the American Chevelle Enthusiasts Society.

MEMBERSHIP APPLICATION
(Print, fill out and mail.)

NAME_______________________________________________SPOUSE___________________

ADDRESS______________________________________________________________________

CITY________________________________________________STATE___________ZIP_______

EMAIL______________________________________________PHONE_____________________

Description of Chevelle(s) owned______________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________
Mail this completed application along with $20.00 to the address at the top of this form, or give both to
any club member. Welcome to the club!