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 No. - _______________________

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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