SWRC        2003 – 2004

                                                Soil and Water Resources Club

                                                UNL Student Chapter Membership Application

 

 

Name: ____________________________________

 

 

E-mail: ___________________________________ Anticipated graduation date: _____

 

 

Major: ___________________________________________________

 

 

Local Address:  _____________________________________________

                       

 

                        _____________________________________________

 

 

Permanent Address: __________________________________________

                       

 

                        _____________________________________________

 

 

Local Telephone #: ___________________________________________

 

 

Social Security #: ____________________________________________

 

 

Annual Dues:  $10.00

 

ð Check                                     ð Cash

 

 

Signature: _____________________________________

 

 

Date: _________________________________________