New Membership Registration Form
Please Print & Mail Completed Forms to:
Adirondack Corvettes,
Inc., P.O. Box 716,
Primary Members Name: (annual
dues$45.00; includes membership in both ACI & NCCC)*
/ .
(optional Birthdate) month/day only
Second Members Name; (choose membership type below by marking with X)
/ .
(optional
Birthdate) month/day only
Second Membership type:
___Spouse or Significant
Other – membership in ACI & NCCC (can vote & hold office) $10.00
___Spouse or Significant
Other – membership in ACI only (can vote). No dues are required.
___Dependent Member aged
16-21 – membership in ACI & NCCC (can vote & hold office) $10.
Address:
______________________________________________________________________
Home Phone #
_____________________________ Cell # (optional) _____________________
Work # (optional)_____________________
Email address:
__________________________________________________________________
Year & Style of Corvette:
_________________________________________________________
Color: ______________________
Engine: ___________________ Other:
__________________
Year & Style of Corvette
#2: ______________________________________________________
Color: ______________________
Engine: ___________________ Other:
__________________
How did you find out about
ACI? ___________________________________________________
Activity or Event you would
like to see as a part of our schedule of events: __________________
*Note: Adirondack Corvettes,
Inc. (ACI) is a local chapter of the National Council of Corvette Clubs (NCCC).
The primary member of ACI must be a member of both ACI & NCCC. NCCC membership is not required for the spouse/significant
other member.
TOTAL $ ENCLOSED:
___________________________________