Join the Husker Power Club

Please fill out and submit this form then send a check with reference to this application made out to the "Husker Power Club" to:

University of Nebraska Athletic Department
Nebraska Development Office-Husker Athletic Fund
One Memorial Stadium
Lincoln, NE  68588-0154

	Name(s):
	Street Address:
	City/State/Zip:
	Home Phone w/area code:
	Work Phone w/area code:
	E-mail Address:
	Membership level:		Select One Core ($50) Strength ($150) Performance ($500) Power ($1000) Champion ($5000)
	Referred By:		Select One Husker Power Club Member Other