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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

Sunday, July 15, 2018

The Annual Picnic will be
this months meeting

Fountainbleu State Park, Pavillion One
US Hwy 190
Mandeville, LA   


See the Event Calendar 
for times

RSVP is a MUST


 



 
 
 
Personalized Plate of the Month
 
  June 2018
 
   
 
    
 
 
 
     
    
 
 
 
Our Club's Sponsor