CORVETTES WEST MEMBERSHIP APPLICATION

PO Box 336177, Greeley CO 80633-0603; www.corvetteswestco.com
Please Print Clearly – Thank You
 

Date: ____________________  Sponsoring Member: ___________________________________________________

Name: _________________________________________________________________________________________

Address: _______________________________________________________________________________________

City: _______________________________________________  State: _________  ZIP: ______________________

Spouse OR Significant Other (S/O): ________________________________________________________________
 
Birthday: Self (Mo/Day): ____________________________  S/O (Mo/Day): ________________________________

Anniversary Date: (Mo/Day):  ______________________________________________________________________

Home Phone:  ______________________  Work: ________________________  Cell: ________________________

Email Address: _________________________________________________________________________________

Driver’s License Number – Self: ____________________________  S/O: __________________________________

Insurance Info – Company: _______________________________  Policy #: ________________________________

Interests/Hobbies You Enjoy: _____________________________________________________________________

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PLEASE PROVIDE INFORMATION ABOUT YOUR CORVETTE(S):

Year: _______________________________   Model: ___________________________________________________

Color: _________________________________________________________________________________________

Describe Your Car: ______________________________________________________________________________

______________________________________________________________________________________________

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