CCC/NCRS Membership Application

 

Name_______________________________________________________

 

Address_____________________________________________________

 

City _________________________________ State _____ Zip ________

 

Phone (Home) _________________________

(Work)             _________________________

(Cell)               _________________________

E-mail            __________________________

National Membership # __________________

(being a member of NCRS National is required to join any chapter of NCRS.)

Join National online at NCRS.org or call (513)-385-8526

Corvettes Owned ________________________________________________________

Description (Year, Body Style, NCRS Awards earned, etc.)

_________________________________________________________

Are you a member of the National Corvette Museum? Yes No

You have permission to publish in the annual roster:

My Name, Address, and Phone Number:  Yes   No

My E-mail Address: Yes   No

 

Signature______________________________________

 

Make $25 annual membership dues check payable to CCC/NCRS and mail to

 

Bill Vyn , Membership

3889 Pueblo Avenue

Santa Barbara , CA 93110

For CCC/NCRS Use Only

Application received: ___________ CCC Membership # ______________

 

Amount enclosed__________

"Great Cars, Great Friends"

Learning, Enjoying, Restoring, Preserving Corvettes