Membership Application
Individual $20 Couples $30 Booster Club $150
New Renewal Advertiser $200
Additional Donation to assist the LVN $ _______

Booster Club and/or Advertiser includes your Individual/Couple Membership

(Your) Last Name: _______________________ First: ____________________
(Spouse/Other) Last Name: _______________________ First: ____________________

Please fill out all info: (We need to update your current address, phone, and email info) Thanks.


Address: _______________________________________________________________________
City: ___________________________ State: _____ ZIP: ____________
Telephone: ____________ Cell: ____________ E-mail address: ________________________

Occupation: ______________________________
Type of Business: __________________________
Business Name: ____________________________
Hometown: _______________________________
College/Univ Attended: ______________________
Occupation: ______________________________
Type of Business: __________________________
Business Name: ____________________________
Hometown: _______________________________
College/Univ: ______________________________

FOR ALL MEMBERS: PLEASE UPDATE this section for the current Club Year:


Member of the U. of Nebraska Alumni Association? Yes ___ No ___  If yes, Annual___ or Lifetime___

I/We would volunteer to assist with the fund-raising (raffle ticket sales and tee-shirt sales) at a Huskers TV game at Bentley's Bar.  The proceeds benefit our Scholarship program for Las Vegas students that attend college in Nebraska. Also, our local charitable contributions including Operation School Bell.
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Las Vegas Nebraskans will take appropriate measures to safeguard the personal information shared with us.


Make Checks Payable to: Las Vegas Nebraskans  
Mail to: Gary Mouden, President
8805 Clear Blue Drive
Las Vegas, NV 89117

More Information. Gary Mouden - 702-378-8113 (cell)

Web Site: (click on membership)