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HomePrintable NSCC Membership Application

 

 

NORTHSHORE CORVETTE CLUB

c/o Dusty Portie, Membership Director

160B Lakeview Drive

Slidell, LA 70458

www.northshorecorvetteclub.com

MEMBERSHIP APPLICATION

(Please Print or Type)

 

AN EMAIL ADDRESS IS VITAL, AS NEWSLETTERS & MESSAGES ARE SENT ELECTRONICALLY

 

 

LAST NAME:________________________________FIRST NAME:____________________________M.I._____

 

ADDRESS:___________________________________________________________________________________

 

CITY:_____________________________________STATE:___________ZIP CODE:________________________

 

BIRTHDATE

(MO/Day):___________________

 

CONTACT INFORMATION (Include Area Code in ALL Telephone Numbers Listed Below)

 

HOME:________________________________________     CELL:____________________________________

 

E MAIL ADDRESS:____________________________________________________________________________

 

SPOUSE / ASSOCIATE INFORMATION

 

NAME:_____________________________________BIRTH DATE(MO/Day):____________________________

 

CELL:_________________________________________     

 

EMAIL ADDRESS:_____________________________________________________________________________

 

 CORVETTE INFORMATION

 

YEAR:__________ BODY STYLE:_______________________ COLOR:_________________________________

 

YEAR:__________ BODY STYLE:_______________________ COLOR:_________________________________

 

INTERESTS (other than Corvettes):________________________________________________________________

 

MEMBERSHIP DUES:   $50.00 

 
 
General Membership Meeting
 
July 30, 2017
 

11AM to 3PM 

Fountainbleau State Park
 62883 Hwy 190 
Mandeville, LA   
Pavilion# 1



 
 
 
Personalized Plate of the Month
 
July 2017