AFCEA Greater Omaha Chapter

Luncheon Registration

Luncheon Registration
Luncheon Registration for 26 JAN 2017
Opportunity to register ends on 20 JAN 2017 at 1200 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

You must complete this if you require access to Offutt Air Force 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 03):    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:
$10.00 Turkey on Ciabatta

Tuscan Turkey on Ciabatta, Deli Mustard Potato Salad, & Fresh Baked Cookies
  $10.00 Roast Beef on Rye

Roast Beef and Swiss on Marble Rye, Deli Mustard Potato Salad, & Fresh Baked Cookies
  $10.00 Veggie Club

Veggie Club on Onion Bun, Fruit Salad, & Fresh Baked Cookies