EmailMe Form - Niagara Corvette Club Alternate Member

Alternate Members

Alternate members must be submitted by the full member with complete information below. If you wish to sign up the maximum of 3 Alternate Members, you will need to fill out a form for each person separately.

The Referring Member will be contacted to confirm the status of the Alternate Member and Payment Requirements

Referring FULL Member's Name *

First Last

Alternate Member Name

First Last

Alternate Member's Date of Birth

MM / DD / YYYY

Alternate Member's Email Address *

Primary Telephone *

### - ### - ####

Can the provided telephone number receive texts? *

Yes

No

Alternate Member's Address

Street Address City State / Province / Region Postal / Zip Code

Corvette Information

For example, Model Z06, ZR1, Stingray...

	Year	Model	Colour	Licence Plate	Convertible? Y/N
Car #1
Car #2
Car #3
Car #4

Membership Terms

Terms & Conditions *

I agree to the terms below

The following membership terms and conditions are accepted by the Full Member on behalf of the Alternate Member that they are registering.

All personal information is not released to members or otherwise without written consent.

Please read the NCC General Membership Waiver & Release Document here. Payment of the yearly membership fee constitutes acceptance of the terms of the waiver.

I understand that as a result of attending club events, I may appear in photos that are posted on the club web page and Facebook page *

Yes, this is understood and I give permission to use these photos

Camera shy! Please do not use any photos of me online

Signature

Clear