Membership Directory
Last Name ____________________ Member First Name
_________________ & Spouse First
Name _____________________
Address:
__________________________________________________________ City
___________________ State __________ Zip ____________
Phone: Home _______________________ Office
______________________ Cell ____________________
email address:
____________________________________________________
CORSA #: ________________________
New Member __________ or Renewal __________
Corvair/Special Interests:
_____________________________________________
Other hobbies/Interests:
______________________________________________
Occupation: (His) ______________________ (Hers)
______________________
Birthday: (His) ___________________ (Hers)
___________________
Anniversary: ____________________
Other Car Clubs:
________________________________
Corvairs Owned/Condition 1
__________________________________________ 2 _____________________________ 3
_________________________________
Other Cars: 1____________________________ 2
_________________________
Additional Information:
______________________________________________ ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________