CORVETTE CLUB OF SOUTH AUSTRALIA INC.

Membership Application

PO Box 230 Findon SA 5023
www.corvetteclubofsouthaustralia.com.au

Membership Type

New Membership

Renewal

Profile Update

Member's Name

Please provide your name.

Date of Birth (Member)

Partner's Name

Date of Birth (Partner)

Is Your Partner an Associate Member?

Yes

Home or Postal Address

Please provide your address.

Phone Number

Please provide your phone.

Can we send club details and newsletters via email?

Yes

Email Address

Please provide your name.

Year

Body Type

Colour

Rego Number

Engine Size

LHD or RHD

Cond. Reg Y/N

How Did You Find Out About Us?

Another Car Club

Word of Mouth

Friend

Website

Previous Owner

Other (Specify)

Please note: All Relevant Fields must be filled in.

Corvette Club of South Australia Inc. Membership Fees from 1ST January to 31ST December each year.

Please include your Full Name and Membership Number when making payment.

Payment Method:

Payment Details (Date Paid, Amount Paid, Receipt Number):

Your membership will be confirmed once your payment has been received.

Please Note, Membership details are NOT released to any third parties under any circumstances