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

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: ________________________
 

YOU
Occupation: ______________________________
Type of Business: __________________________
Business Name: ____________________________
 

Hometown: _______________________________
College/Univ Attended: ______________________

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

Hometown: _______________________________
College/Univ: ______________________________

FOR ALL MEMBERS:

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

Would you &/or spouse/other help with Assembling & Boxing the Holiday Food Boxes, one night in mid-December? Yes _____ No _____

We will resume activities as state-wide guidelines allow and club projects (scholarships, monetary support, etc. to UNL) as club finances permit.

_______________________________________________________________________________

Privacy Statement
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: Gary Mouden
8805 Clear Blue Drive
Las Vegas NV 89117

More Information. Gary Mouden, President (702) 378-8113 Anytime or
Nancy Herrod, Acting Membership Chairman (702) 371-1428 Evenings
Stay Updated on Las Vegas Nebraskans Information: www.lasvegasnebraskans.com or LVN Hotline 702-223-6992.