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:  Jr. Int.Sr.

Send Registration Form to:
Junior Nebraska Cattlemen
Kelsey Lamb
24518 A Street
Elmwood, NE 68349