Greater Moncton Corvette Club

  2017 Membership Form

$25 Membership Fee

First name:

Last name:

Partner
First name:

Last name:

Address:

City:

Postal Code:

Telephone Number:

Mobile \ Work Telephone Number:

Email:

 

Vehicle Information

Year: Style: Color:

 

For more information contact/Pour de renseignments en franšais, contactez:

Roger Bourgeois at 506-858-7895 or email: corvettefun@rogers.com 

* Please be assured that your e-mail will be used for club activities only. 

You may bring this form with the $25 membership fee to our meetings or mail to our

Treasurer:  

Wornick Price, 2918 Fredericton Rd., Salisbury, NB  E4J 2G1

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