University of Nebraska - Lincoln Online Entry Form

You will receive an e-mail confirming that your registration has been received after you complete the form and click on the Secure Checkout button at the bottom of this page.

Fields indicated with an asterisk(*) are required.

Participant Information
First Name
*
Last Name
*
Age
*
Member Code(numeric portion only)
*
E-mail
*
Address
*
City
*
State
*
Country
*
Zip
*
Jr Member Cell Phone
*
Is this your first time attending Raising the Bar?
Please Select
T-Shirt Size
Mode of transportation
*
(If flying, flight schedule must be e-mailed
or faxed upon completion of this form.)
Select the option(s) that best describe your background.
Do you raise other livestock in addition to cattle?
Do you raise crops in addition to cattle?
Dietary Restrictions:
Please select yes or no if you will need gluten free meal options.
Are you observing Lent and need a non-meat option on Friday?
Please list below additional dietary needs staff should be aware of.
In case of emergency please notify:
Name
Cell Phone
Address
City
State
Country
Zip
If not available please notify:
Name
Cell Phone
Address
City
State
Country
Zip
Please list any medication participant is allergic to
Please list any food the participant is allergic to
List any existing medical conditions
List any medications participant is taking
Do you allow Association staff to give your child over-the-counter medication?
Yes No
If yes, please list:
List any other existing condition, medical or otherwise, the staff should be aware of
Payment Information

Billing Information

* *

Credit Card Information

Last 3 or 4 digits on back of card.
Clear