Adirondack Chapter
NCRS
Application Form
Name: ________________________________________________
Address: ______________________________________________
________________________________________________
________________________________________________
Phone# ______________
E- mail: ______________
NCRS#______________ Date: ____________
Corvette Owned : Year_______ Coupe / Roadster Color ___________
Note: You do not have to own a Corvette to join
YOU MUST BE A CURRENT NCRS NATIONAL MEMBER TO JOIN
DUES WILL BE $30.00 PER YEAR
Send a check with Application to:
Jim Sabia
585 Main Street
Poughkeepsie, New York 12601
Phone: (845) 454-8250
or
sabiaauto@verizon.net
Make check payable to Adirondack Chapter NCRS Treasurer
For more information on the internet :
http://www.adirondackncrs.com
ADIRONDACK CHAPTER - CHAIRMAN
Lief Larsen
217 First Street
Scotia, New York 12302
llarsen@mmcmillwork.com
(518) 465-4109