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: ____________________ Please fill out all info: (We need to update your current address, phone, and email info) Thanks.
Address: _______________________________________________________________________
|
Type of Business: __________________________ Business Name: ____________________________ Hometown: _______________________________ College/Univ Attended: ______________________ |
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___
|
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: Lasvegasnebraskans.com (click on membership) |