We are always ready to welcome new members!  Simply print this form and either bring it to the next meeting or mail it.

                                                 Southwest Florida Corvette Club

                                                             P.O. Box 6951

                                                     Fort Myers, Florida 33911

For more info call:  Marshall Lieberman 239-768-2882 or Judy Galewski 239-574-2571

                                              Membership Application / Renewal

Name: ___________________________________________________________

Address: _________________________________________________________

City, State, Zip: ___________________________________________________

Phone: __________________________________________________________

Cell: ____________________________________________________________

E-Mail: __________________________________________________________

                                                       Type of Memberships

      ____ Single (New) $45                                        ___ Renewal $40

     ____ Couple (New) $65                                       ___ Renewal $60

DOB (Month and Day) ______________________________________________

Name of spouse or significant other: __________________________________

Spouse DOB (Month and Day) _______________________________________

Anniversary (Month and Day) _______________________________________

Year, model and color of your Corvette ________________________________

Activities that interest you:  ________________________________________

For more information about the club go to www.swflcorvetteclub.com