Northern Illinois Chevelle Club Registration

This registration will provide information about members Chevelles and Monte Carlos.  Information received will provide easy cross reference for members with the same series car and help expand the knowledge of Chevelles and Monte Carlos.  Please give info. for each Chevelle and Monte Carlo that you own.  If you have more than one car just submit car information then complete the form again, only your name will be needed on the subsequent forms.  Send check or money order for $20 to (George G. Primm, 2 Cebula Ct., Bolingbrook, IL.  60440-9005) or you can pay through PayPal after the submission of this form.

Personal Information:

Full Name
Spouse
Address
City
State (2 letter)
ZipCode
Phone Number     
Email Address
Alternate Email

Chevelle/Monte Carlo Information:

Year
Model
Body Style
 

Drivetrain Info

  
Engine
 
Engine Original

Modified
Transmission
Rear End
Brakes
 

Colors

  
Body
Roof
Interior
 
Colors Original

Modified
Accessories
Check all that apply Power Steering

Power Brakes

Power Windows

Power Seats

Power Door Locks

Power Trunk Latch

A/C

Tilt Wheel

Wood Wheel

AM

AM/FM

AM/FM/Tape

Other:
Any other

interesting facts:

Interests:

Drag Races

Local Shows

Picnics

Cruises

Other Interests:
What months are you most active with your car?                   

January  -  February

March  -  April

May  -  June

July  -  August

September  -  October

November  -  December

 

Summary of how you obtained your car:

         

How did you hear about the NICC?

         

Northern Illinois Chevelle Club.
Copyright © 2008 [NICC]. All rights reserved.
Revised: 06/23/08.