AFCEA Greater Omaha Chapter

Luncheon Registration

Luncheon Registration
Luncheon Registration for 13 APR 2017
Opportunity to register ends on 06 APR 2017 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

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:
$17.00 Mango Chicken

Mango soy sauce chicken, home style mashed potatoes, and green beans.
  $17.00 Chef Salad

Chef salad