NAME:  ___________________________________

 

SPOUSE:  __________________________________

 

ADDRESS:  ________________________________

                     ________________________________

                     ________________________________

 

HOME PH:  ________________________________

CELL:  (HIS)  ______________________________

CELL:  (HER) ______________________________

 

E-MAIL ADDRESS/ES:

                        ________________________________

                        ________________________________

 

VETTES:____________________________________

____________________________________________

____________________________________________

____________________________________________

 

Mail To:     Triad Corvette Club

 P.O. Box 988

Kernersville, N.C. 27285