Membership Application

Please fill out the information below, and press "submit" when you're done.  You'll be taken to a confirmation page where you can submit your payment by PayPal, using any credit card or your individual PayPal account. See the text below this form if you'd rather send us a check.

Joint application, click here

  Renewal Application
Name:

Class: Degree and Year:

Address:

City:   State:    Zip:

Home phone: 

Maiden name or Spouses's name:

Employer:

Business City:

Business State:   Business Zip: 

Business Phone:

Fax:    Cell: 

Email:

Check if your information has changed from last year

Check if you do not want a listing in the CCFC Club Directory

If you don't want to use our form with PayPal, we have an Adobe Acrobat Membership form which you can fill out on your computer, print, and mail to Dotty Kesten with the appropriate check. You'll need Acrobat Reader 5 or greater to fill out the form.

Click here to download the form into your browser. Then, type your information into the various lines on the form. Print it out, and mail it together with your check payable to "Cornell Club of Fairfield County" to:

CCFC
c/o Dotty Kesten, Treasurer
1 Crestwood Road
 Westport CT 06880