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:
*
Sex:
*
Male
Female
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
Radio
Television
Other
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
Other
Are you willing to take an active
role in our organization?
Yes
No
Not sure
*
Are you a registered voter in Nebraska?
Yes
No
*