OKLAHOMA CORNHUSKER CLUB

Established in 1981

P.O. Box 470924 - Tulsa, Oklahoma 74147-0924

www.infoman.net/occ

MEMBERSHIP APPLICATION

Name: _________________________________Spouse: ________________________________

Hometown:______________________________ Hometown: ________________________________

Mailing Address:_____________________________________________________________________

City, State, Zip: ___________________________________________________________________

Phone: ________________________________ FAX: _____________________________________

Email: _____________________________________________________________________________

Employer:_______________________________ Spouse’s Employer:___________________________

Phone:_________________________________ Phone:_____________________________________

Are you a member of the Nebraska Alumni Association: Yes ___ No ___

Chapter affiliation TULSA ___ OKC ____

Please check any of the following committees you would be interested in serving on:

___ Calling ___ Watch Party ___ Christmas Banquet ___ Publicity ___ Directory ___ Golf Tournament

ANNUAL MEMBERSHIP DUES = $20.00

Each year the club donates $1,000.00 to the Nebraska Scholarship Fund. Please give what you can to

help us continue with this and include it in your check made payable to: Oklahoma Cornhusker Club.

Membership Dues: $20.00 + Scholarship Fund: __________ = __________

Signature: _________________________________ Date: ________________