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Print this form and mail to the address below:

Northern New York Corvette Club

c/o of Betsy Jacobs

42992 Seaway Ave.

Alexandria Bay, NY 13607

$20.00 annual fee payable to NNYCC

 

Membership Application/Renewal

Name:___________________________________________________________________

Significant Other:_____________________ Relationship:________________________

Address:____________________________________    City_______________________

State/Province:________________________      Zip Code:________________________

Home Phone:_________________________  Work Phone:________________________

Year of Car:_____________________   Coupe/Convertible/Hardtop:_______________

Color:_____________________     Special Feature(s):____________________________

Email Address:____________________________________________________________

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