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Print this form and mail to the address below:

Northern New York Corvette Club

1152 Harrison Street

Watertown, New York 13601

nnycc@twcny.rr.com

$20.00 annual fee payable to NNYCC

Membership Application

Name:__________________________________________________________________

Significant Other:___________________ Relationship:_________________________

City:___________________________________________________________________

Address:________________________________________________________________

State/Province:_____________________      Zip Code:__________________________

Home Phone:_______________________  Work Phone:________________________

Year of Car:_______________________   Coupe/Convertible/Hardtop:____________

Color:________________________      Special Feature(s):_______________________

E-Mail Address:_________________________________________________________

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