Membership Form

When was your first visit? *

Example: Breakfast, 5/6/2021

When was your second visit? *

Example: Breakfast, 5/6/2021

When was your third visit? *

Example: Breakfast, 5/6/2021

Your Name *

First

Last

Your Birthday (mo & day) *

Ex: 11/15

Spouse/Significant Other's Name

First

Last

Spouse/Significant Other's birthday (mo & day)

Ex: 11/15

Address *

City | State | Zip

Home Phone

Ex: 602-601-1929

Cell Phone #1 *

Ex: 602-601-1929

Cell Phone #2

Ex: 602-601-1929

Email #1 *

Email

Confirm Email

Email 2

Email

Confirm Email

First Car Year / Color / Model *

Ex: 1979 Rally Red C3 Coupe

Second Car Year / Color / Model

Ex: 1979 Rally Red C3 Coupe. only list current corvettes

Third Car Year / Color / Model

Ex: 1979 Rally Red C3 Coupe

Branch of service, if applicable

How did you hear about SCCC?

Name *

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Last

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