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NCRS St. Louis Chapter

APPLICATION FORM

Annual Family Membership Dues:  $15.00

(Late renewals after January 20: $20.00)

Make checks payable to: NCRS St. Louis Chapter

 

For information, contact the Membership Chairman, Tim Parker (314) 894-9698 or Kelly Waite (636) 458-3075:   

New membership applications received after September are honored for the following calendar year.

 

New Member 

 

National NCRS Membership #: 

Renewal 

 

National membership is required, use separate application if necessary.

Name:      

Birth Date (MO/Day)

Spouse:   

Birth Date (MO/Day)

Address: 

   

City:                

State:     Zip:

 

 

    

Occupation:

Phone (Work):

Spouse's Occupation:

Phone (Work):

Phone (Home):

Cellular Phone:  

E-mail:

 Pager:

 

 

 

Please list Corvette model(s) that your cuirrently own.  This information is for club use only.

Year

   Body Style:  
   
   
   

 

Mail Application Form and Check to: 

Joan Burnett     

250 West Hwy U

Troy, MO 63379

 

     National NCRS Application Form:  Join NCRS Here! 

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