Membership Application

Date of Application:_____________________

Applicant's Name:________________________

Spouse's Name:_________________________

City:________________ State:___

ZIP:________

e-mail:______________________

Phone:(     )__________________

Birthday:___________ (Spouse's) Birthday:___________ (Applicant)

Anniversary:________

Corvette Information:

Year:_____ Model:________ Color(s):__________

Year:_____ Model:________ Color(s):__________

Interest: (check all that apply)

How did you find out about FCO??___________________________________________________

_______________________________________________________________________________

Membership is limited to Corvette owners and their spouses or significant others.
The annual dues are $48.00 (prorated) per household.
Upon acceptance of your application you will become a full voting member.

Please Print and Mail to: FCO, P.O. Box 53, Mystic, CT 06355