Membership Application

KANSAS CORNHUSKER CLUB

Name: _____________________________________________________

Street Address: ______________________________________________

City, Zip Code: ______________________________________________

Phone: _____________________________________________________

E-Mail: _____________________________________________________

Spouse’s Name: ______________________________________________

Children’s Names: _____________________________________________

_____________________________________________________________

Nebraska Home Town: _________________________________________

Graduation Year – UNL: _____________________

Other Nebraska College: ________________________________________

Annual Membership Dues -- Family $25 Single $20
Payable to: Kansas Cornhusker Club

Send To: Kevin Meyer
KCC Membership Director
519 E. Marion Rd. #312
Wichita, Ks 67216