MASON DIXON CHAPTER, NCRS
Chapter Membership
Chairperson
Bill Wagner 2 Manor Crossing Ct. Baldwin, MD 21013
410-592-3098
willsan1@verizon.net
Membership Application
(National NCRS membership is required for chapter membership)
Name: ___________________________________________________________________
Address: _________________________________________________________________
City: ____________________________________________________________________
Phone Numbers: Home( ) ___________________ Work ( ) __________________
Fax ( ) ___________________ E-Mail Address _______________
NCRS Membership Number: __________________(required for Chapter Membership)
Corvettes Owned:
Year Model Engine/Trans Options
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
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Dues: (Make check payable to MASON DIXON CHAPTER of NCRS)
Check One
$35.00 for One Year ______ $150.00 for Five Years ______ $300.00 for Lifetime______
Print off and fill in
Application
Mail Check and Application to:
Chapter Membership
Chairperson
Bill Wagner 2 Manor Crossing Ct. Baldwin, MD 21013
410-592-3098
willsan1@verizon.net