Fathers' Rights of Nebraska Membership Application

To become a member of Fathers' Rights of Nebraska, please fill out and submit the form below.

User Name: *
Password: *
First Name: *
Last Name: *
Age: *
Email Address: *
Address: *
City: *
State: *
Zip: *
Home Phone:
ex. "4025551212"
Work Phone:
ex. "4025551213"
Cell Phone:
ex. "4025551214"
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 Nebraska? *