(Please Print)
Name _______________________________________________________
Complete Mailing Address ___________________________________
____________________________________________________________
Telephone (_____)________________________
FAX (_____)________________________
E-mail Address ______________________________________________________________
Year admitted to the Nebraska Bar: ___________
Type of Membership:
___ NSBA Member 5 years or more - $125.00
___ NSBA Member less than 5 years - $90.00
___ NSBA Member less than 1 year - $50.00
___ Sustaining Member - $250.00
___ Associate Member - $85.00
Please send this form with your check to: NCDAA, P.O. Box 94973, Lincoln, NE 68509