// Membership Application

Would you like to become a member of the Northeast Kansans for the Nebraska Cornhuskers? You can recieve all of the benefits of membership by filling out the application and sending it to us. 

Northeast Kansans for Nebraska Membership Form

Name: _______________________________(Spouse)_______________________________

Address: ____________________________________________________________________

City: ___________________________ State: _________ Zip: __________________________

Home Phone: (_________)______________________________________________________

*Email Address: _______________________________________________________________

*Occupation/ Employer:________________________(Spouse)___________________________

*Work Phone: (_________) ______________________(______)_________________________

*Cell phone: (_________) ______________________(______)_________________________

Hometown: _________________________________(Spouse)___________________________

Class of: ________________________________________________________ (if NU graduate)

*We would like this information to be able to contact you. Please indicate if you do not want this information listed in the membership directory.

Enclose check to Northeast Kansans for Nebraska for $17.00 or only $15.00 if you’re a UNL Alumni Association member and mail to:

Bob Elliott
3405 SW Atwood Avenue
Topeka, KS 66614