AFCEA Greater Omaha Chapter

Luncheon Registration

Luncheon Registration
Luncheon Registration for 25 FEB 2016
Opportunity to register ends on 17 FEB 2016 at 1700 hours

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Tell us about yourself

Rank / Title:    First Name:    Last Name:

Military Organization:    Contractor Corporation:

Email:    Work or Cell Phone:

Do you have an AFCEA Membership?: Yes No

Do you know your member number?: Yes No    If yes, type it here:

Are you a club member? Yes No

Last 4 of Club Card Number ($2 discount for AFCEA): Expires: Month Year

Are you a Program Sponsor? Yes No

Will you need assistance getting on base?: Yes No

Additional information for base access:
(If you do not have a driver's license, you may enter similar details for a state issued ID or a student ID.)

Date of Birth (Example: 1962 Jan 11):    Gender: Female Male

Full Name (as shown on driver's license):    US Citizen: Yes No

License Number / Student ID:    License State / School:

Select a menu item:
$15.00 Chicken Marsala

Chicken marsala, mashed potatoes and Chef choice vegetables
  $15.00 Chef Salad