NEBRASKA MILITARY RETIREE COUNCIL MEMBERSHIP FORM

Mail Membership to:

Nebraska Military Retiree Council
P.O. Box 5765
Lincoln NE 68505-5765

Membership is $5.00 per year and you can pay up to 10 years.

My remittance for __________year(s) X 5 = $ ____________.
OR
I have reached the age of 85 and wish to remain a member without the
payment of dues _____ (Initials).

Name ________________________________________________________________

Address ______________________________________________________________

(City)___________________________________ (State) ________ (Zip)______

Home Phone Number: ____________________________________________________

Name of Spouse ________________________________________________________

Branch of Service _______________________________________________________

E-Mail Address _________________________________________________________

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