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

If you would like to make a donation to the radio or scholarship fund, please enclose any donations when you become a member or renew your membership. Please indicate which fund your donation is to be applied. Please send all donations to the above address.

$________ Donation to _____ Radio Fund _____ Scholarship Fund

_____ I’d like to join the Nebraska Alumni Association for $35 (single) or $45 (couple)
Please enclose a separate check payable to the Nebraska Alumni Association