Virtual Vairs Membership Registration

Please follow the instructions.

Membership Registration: This form enables you to add your personal info to our database if you have never submitted a membership record and are receiving VV mail.

Note: This form is currently only partially active - your info is stored on the server, but is not immediately viewable on the Membership Roster. Please send any comments or problem reports to to:emarschn@gmail.com

Membership Registration
NOTE: PLEASE FILL OUT THE FORM COMPLETELY AND USE UPPER AND LOWER CASE WHERE APPROPRIATE.

*Name:

	*First:
	Middle:
	*Last:

*E-Mail Address:
an incorrect address will cause your request to fail

Personal Web Page:

The remainer of the information, while required, will be kept private and used only in CORSA related correspondance if requested. Check the below box if you wish the following personal info to be kept private. If left unchecked your information will be searchable via our public database.

Use info for CORSA related business only

*Street Address:

line 1:

line 2:

*City:

*State:

*Zip:

*Country:

Organizations

	I am a member of the Corvair Society of America (CORSA)
	I am NOT a member of CORSA (Corvair Society of America)
	Please email me contact information for the Corvair Society of America

I am a member of a local Corvair Club:

1)

2)

3)

Corvairs Owned

Please enter year, model, color, and brief description per car. (one car per line)
i.e.: 1963, Monza 900 cpe, pg, red ext./saddle int. This car is my intro to 'vairs. <CR>
1962, Monza Station Wagon, I'm on the lookout for one! <CR>

Tell us more about yourself:

Please type a password for your information. A password is needed so that only you can make changes to your information. (Please use only letters and numbers--no punctuation or spaces.)

Password:

That completes entry of personal information.

Please check your information carefully before submitting your request.

Your Member Information will be added to the Member Roster as soon as humanly possible.

Questions? Contact Eric Marschner at emarschn@gmail.com