Membership Application

Date: ____________________________

Name:____________________________(check one) Male Female

Date of Birth:_____________________

Address:______________________________ 

City:________________________

State:_________________________ 

Zip: _________________________

Phone Number: (____)____-______  

Email Address:________________________

Parent or Guardian:___________________________________________________

Local Newspaper Name:______________________________________________

Newspaper Address:__________________________________________________

Paid:_____    Check Number:________

Notify using (check one):   Email   Postal Mail System

Email Address: ____________________________________________

Showmanship Age As of January 1^st : 
Jr. (8-11) Int. (12-15)Sr. (16-21)

Send Registration Form to:
Junior Nebraska Cattlemen
Kelsey Lamb
1472 N. 28th Road
Avoca, NE 68307