Sustaining Life Member Information
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Sustaining Life Information
* required information
First Name:*
Middle Initial:*
Last Name:*
Maiden Name (or other name used):

Current Address:*
City:*
State:*
Zip:*
Country:
Email Address:*
Current alumni membership number (optional):
Are you a University of Nebraska graduate?
Yes   No
Home Phone:
Business Phone:
Student Number (if applicable):
Promotion Code (if applicable):
Comments:
I would like to make a tax-deductible contribution to help sustain student and alumni programs at the following level (please check one, indicating specific amount in the space provided):
Mueller Tower Level ($1500+) $
Hail Varsity Level ($1000 - $1499) $
Scarlet & Cream Level ($500 - $999) $
Columns Level ($250 - $499) $
Ivy Level ($25 - $249) $
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