Fathers' Rights of Nebraska Membership Application  

To become a member of Fathers' Rights of Nebraska, please fill out and mail in the form below.
First Name: *
Last Name: *
Sex: *
Age: *
Email Address: *
Address: *
City: *
State: *
Zip: *
Home Phone:
Work Phone:
Cell Phone:
How did you hear about us? Referred by a member  
Read an ad, flyer, or card
What is your main reason for joining? I want/deserve to be with my children more
I support all of your goals
I support some of your goals and believe fathers who are fit and able deserve equality
Fathers in Nebraska have been discriminated against for far too long and a change is long overdue
I believe this is best for children
All of the above
Are you willing
to take an active
role in our organization?
* Are you a registered voter
in the state of Nebraska?
Fathers' Rights of Nebraska
7914 West Dodge Road #310
Omaha, NE 68114
OR fax it to: 391-DADS (3237)