Colorado Springs Corvette Club Prospective Member Form

Primary Member Information
*First Name: *Last Name:
Email Address:

Spouse /Significant Other Information
First Name: Last Name:
Email Address:

Address and Phone Number Information
*Street Address:
*City: *State: *Zip Code:
Home Phone (ex: (719) 555-1212): Cell Phone (ex: (719) 555-1212):

Corvette Information
*Car Year, Color, Body Style:
Club Information:
Do you know any Club Members? Yes    No     Club Member's name:
Interests: