National Corvette Restorers Society

Arizona Chapter

Membership Renewal

 

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

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)

 

 

Dues are $20

 

Make check payable to:  Arizona Chapter NCRS

 

Mail completed form and check to:

    Dave Barclay

    831 N. Circulo Zagala

    Tucson, AZ 85745