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MEMBERSHIP FORM

All personal information is used solely for Nebraska Society activities, information is never traded or sold. All memberships are fully tax deductible.

Click here to download a pdf version of our Membership Form.


Name*  
Spouse  
Address*  
 
City  
State  
Zip
Phone: (H)*  
(O)
E-mail*  
Hometown  
Maiden Name  
(If applicable)  
College/University  
Occupation/Employer  
  * Required Fields

Membership Categories  

  Senior or Student Membership

1 Year ($15)  
 
    Individual Membership 1 Year ($25)    
    Family Membership 1 Year ($40)    
  Patron Membership ($150-$499)
  Bronze Membership ($500-$999)
  Silver Membership ($1,000-$2,499)
  Gold Membership ($2,500-$4,999)
  Platinum Membership ($5,000-$9,999)
  Diamond Membership ($10,000)

Please check here if you DO NOT want your information included in a Nebraska Society Directory.

YES!  I would like to become more involved in the Nebraska Society by volunteering to help with the following event / activity:
       Distinguished Nebraskan Award Dinner    Cherry Blossom Festivities
       Taste of Nebraka     Nebraska Socials      Internship Program
       Softball Tournament     Golf Tournament     Other:


   OR


© 2008 The Nebraska Society of Washington, D.C., Inc. All rights reserved.                           Post Office Box 65243, Washington, D.C. 20035-5243