Membership Application 2008-2009
Dues: Single Membership $20.00 Family Membership $30.00
(Please Circle)
Membership Includes:
Please complete the following information:
Name: ____________________________ NU Class of ____
E-mail: ___________________________
Hometown: ________________________
Spouse: ____________________________ NU Class of ____
E-mail: ____________________________
Hometown:_________________________
Home Address:__________________________________
City/State/Zip: __________________________________
Home phone:______________ Work phone:______________
Nebraska Alumni Association membership status: (Please Check One)
You: ___ Annual ___ Life ___ Non-member ____ Interested in Joining NAA
Spouse:___ Annual ___ Life ___ Non-member ____ Interested in Joining NAA
I am interested in helping the Kentuckiana Huskers grow even more and would like
information about how I might be of service! ___YES ___ NO
Please complete this form, make check payable to
Kentuckiana Huskers and mail to:
Mark Evans, 305 Coralberry Rd., Louisville, KY 40207
For administration purposes only:
Year 2008-2009 paid member __ yes __no
Date paid: _______Amount paid _______ method of payment: _______
Member since: __________ (= consecutive years)
