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NATIONAL CORVETTE MUSEUM AUTOMOBILE EXHIBIT APPLICATION

Applicant Name

_____________________________________

Address

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

C i t y / S t a t e / Z i p _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Home Ph:

Bus. Ph:

_______________

___________________

E-mail: ____________________________________________

Brief bio of Auto for which application is made and description of condition: (use separate sheet if necessary or attach previously prepared bio)

1.

Are you a member of the National Corvette Museum?

___

Yes

___

No

2.

3.

4.

(Anyone wishing to exhibit an Auto must be a member.) Do you currently maintain property insurance on the above Auto? Yes No ___ __ If so, please state insurer and amount insured. __________________________ What time frame do you wish to loan Auto to the Museum? ________________________________________________________________ Method of transport you will be using to deliver Auto to and from the Museum:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

*Applicant will be required to provide proof of ownership or authority to exhibit Auto and to complete Automobile Loan Agreement prior to exhibition of Auto at Museum.

*Applicant will be notified by Museum of acceptance of Application.

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