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: ______________________________

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

  • help with the Annual Banquet?  Yes____ No____

  • help with the Holiday Food Drive?  Yes____ No____

  • help with the scholarship fundraising by assisting at a televised game?  Yes____ No____         

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

________________________________________________________________________________

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:
Duane Irons
4355 S. Durango Drive - #209
Las Vegas, NV 89147

More Information. Call Duane 702-684-3624 (Evenings) or lvhuskers1@yahoo.com