National Corvette Restorers Society

Arizona Chapter

Membership Application

 

(Please Print this form and , fill it in its entirety.)

Check One:  (  ) New Member  (  ) Renewal (  ) Information Update Only        Date: ____________

 

Name: Last_____________________First____________________Spouse___________________

Street Address: _________________________________________________________________

City: ________________ State: ____ Zip Code: ____________Email: _____________________

Phone:  (home) (        )______________________  (work/daytime) (        )_____________________

 

NCRS National Membership Number: ___________________   (on Restorer Magazine mailing label)

(Note: Must have National membership to apply for local chapter membership)

 

Car Information:

Year: ________Style: _________________Color: (Ext)_______________(Int)_________________

Engine(Ci/HP): ___________Awards(type/date): ________________________________________

Notable Options: _________________________________________________________________

 

Year: ________Style: _________________Color: (Ext)_______________(Int)_________________

Engine(Ci/HP): ___________Awards(type/date): ________________________________________

NotableOptions: _________________________________________________________________

 

Year: ________Style: _________________Color: (Ext)_______________(Int)_________________

Engine(Ci/HP): ___________Awards(type/date): ________________________________________

NotableOptions: _________________________________________________________________

 

Roster: Please do not list my

Car____ Address____ Phone____

Contact Preference:

Phone ____ Email ____ Either ____

Comments/Suggestions: