Capital City Corvair Club Membership Form

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Please print this out and send it to the address on the Contact page.

Member Information Form

Member since: _________ If New Member, amount paid: _______ Date Paid: _________

Name(s): ______________________________________________________________

Address: _________________________ City: _____________ State: ___ Zip: ________

Home Phone: ( )_____________________ Work Phone: ( )________________________

E-mail Address(s): ________________________________________________________

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The following information is optional but will allow us to better get to know you and your family.

Name: ______________________________ Occupation: _________________________

Spouse: _____________________________ Occupation: _________________________

Your Birthday: ______________ Spouse's Birthday: _________ Anniversary: ___________

Children: ________________________________________________________________

Info on Corvair(s) you own (year, model, options, anything special about it/them):

_______________________________________________________________________

Are you a CORSA member? Y / N Any other club affiliations? : ______________________

Other interests or hobbies?

Yourself: ________________________________________________________________

Spouse: _________________________________________________________________

Capital City Corvair Club (CCCC) was established in 1963 and became a chapter of the Corvair Society of America (CORSA) in June of 1980. Regular meetings are held the second Tuesday of each month at various locations and are publicized in the CCCC Exhaust newsletter mailed to each member monthly. Annual club dues are $12.00 per year, renewable each April and payable to: Capital City Corvair Club. Initial enrollment includes (1) engraved name tag (additional nametags available at $3.00 each). All CCCC members are strongly encouraged to join and maintain CORSA membership in order to preserve the Corvair marque and cooperation between other CORSA chapters.