FIRST CAPITAL CORVETTE CLUB MEMBERSHIP
Name (Last, First)
_________________________________________
Spouse’s Name (First)
_________________________________________
Street address
_________________________________________
City/State/Zip
_________________________________________
Telephone
Home:
___________________
Work:
___________________
Cell:
___________________
Additional:
___________________
(please indicate h/w/c)
E-Mail Address(es)
____________________________________________
____________________________________________
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Important Dates
Birthday: Hers_________________________ His__________________
Anniversary________________________________________________
Car 1:Year_______ Coupe/Conv.________
Color___________
Car 2:Year_______ Coupe/Conv.________
Color___________
Car 3:Year_______ Coupe/Conv.________
Color___________
The information provided will be kept on file by First Capital Corvette Club for
members only.
The FCCC will only publish members first name(s), a provided photograph some members choose to photograph their car(s) other members choose
photographs including themselves with their car(s); the choice is yours and
provided email address.
Please mail completed application to:
First Capital Corvette Club, Attn: Membership
496 Mountain View Avenue
Hurley, New York 12443
Application fee of $ 25.00 can be paid directly at the monthly meeting to the
FCCC treasurer.
Questions may be directed to [email protected], please
reference First Capital Corvette Club – membership in the heading.
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