Your Name (required)Your Email (required)Address (required)City (required)State (required)Zip (required)Home Phone (required)Work PhoneCell PhoneBirthday mm/dd (required)Spouse/Significant Other NameSpouse/Significant Other Birthday mm/ddSpouse/Significant Other Email AddressCorvette YearBody StyleCoupeConvertibleColorTranmissionAutomaticManualSecond Corvette YearBody StyleCoupeConvertibleColorTranmissionAutomaticManualSpecial InterestsScan the QR code below to complete your new membership registration:Enter $35 for the amount.Enter “Dues” in the “Add a note” field.Review and send.Payment by check payable to CCND can be mailed to:CCND210 Tinsley CtNewark, DE 19702Payment by cash to Neil Smith, Bruce Yearsley or Mike Metcalf can be made at a club function.