Membership Application
Individual $20 Couples $30
New Renewal
Holiday Food Drive Donation $ _______

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Please complete all areas: (Printable form)

(Your)Last Name: _______________________ First: ____________________
(Spouse/Other)Last Name: _______________________ First: ____________________
Address: _______________________________________________________________________
City: ___________________________ State: _____ ZIP: ____________
Telephone: ____________ Cell: ____________ E-mail address: ________________________
 
YOU
Occupation: ______________________________
Type of Business: __________________________
Business Name: ____________________________
 

Hometown: _______________________________
College/Univ Attended: ______________________

SPOUSE/OTHER
Occupation: ______________________________
Type of Business: __________________________
Business Name: ____________________________
 

Hometown: _______________________________
College/Univ: ______________________________

Are you a member of the U. of Nebraska Alumni Association? Yes ___ No ___  If yes, Annual___ or Life___
Would you:

  • serve on a special committee?  Yes____ No____

  • help with the Annual Banquet?  Yes____ No____

  • help with the Holiday Food Drive?  Yes____ No____

  • help with the Scholarship fund-raising?  Yes____ No____

  • assist at one of the televised games at Torino’s?  Yes____ No____         

Are you or your business interested in advertising during our football broadcasts? Yes ____No____

Other activities would you like to have the club organize or support?_________________________

________________________________________________________________________________
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Las Vegas Nebraskans will not disclose personal information to third parties without the individual's permission and will take appropriate measures to safeguard the personal information shared with us.

Make Checks Payable to: Las Vegas Nebraskans
 
Mail To:
Wayne Rothmeyer

La Vegas Nebraskans

2917 Billy Casper Drive
Las Vegas, NV 89134

More Information. Call: Wayne 233-5677 or LVN Hotline: 223-6992 and/or renyaw@aol.com