Nebraska Coast Connection

NCC CHAMPION FORM

FIRST NAME / LAST NAME
Check your birth certificate or your last movie credit.

COMPANY
Where your paycheck comes from.

OCCUPATION 1, 2 and 3

What do you do when you go to work? What else? What else?

OTHER OCCUPATION

What do you do when you need some extra cash?

DREAM JOB

What do you think you'll be doing when you retire?

USER NAME

Please enter your first and last name without spaces. This is the name you will use to access the champion areas of the site.

PASSWORD

This is the password you will use to access the champion areas of the site. Don't forget it. We don't want to be reminding you all the time.

ADDRESS, CITY, STATE, ZIP

When you go home from work, where do you go?

EMAIL

How can we contact you when your phone is busy?

PREFERRED PHONE

Which phone has the nicest ring? The one at work? The one at home? The one in the garage?

SECOND PHONE

What if that last one is busy? We promise we won't use this one unless we have to. (and we probably won't have to)

FAX

Like anybody has a fax at home. How about at work?

CONNECTION TO NEBRASKA

Did you live there? Did you fly over? Did you watch a Husker game? When? where?

BIO

Who are you .... really?

MORE INFO

We hate secrets. Tell us a little about your business, talents or services.

CREW

Please help us out if you can. A few hours here and there will do wonders!

CONTRIBUTION

Now the money part. Help us with what you can. We'll help you too.

DIRECTORY

This is how your listing will appear in our directory. Click the button "use from above" and it will fill in the blanks below. You can change anything you want. If you don't want something in your listing just leave it blank!

First Name:
Last Name:
Company:
Occupation #1: You may select up to three occupations to be listed in the directory. If you don't find your occupation you may type it in other.
Occupation #2:
Occupation #3:
Other Occupation:
Dream Job:
Username: Please enter your name with no space between first and last. You may also use your company name for a user name. This will be used to access the NCC Directory.
Password: Remember your password. This will be used to access the NCC Directory.
Address:
City:
State:
Zip:
Email:
Preferred Phone:
Second Phone:
Fax:
Connection to Nebraska:
Bio:
More Info: Use this field for any information you'd like to provide about yourself to the NCC Directory.
Crew - (Volunteer, Other):
Champion Contribution:	Producer $35 Executive $75 Star $150 Legend $500
DIRECTORY The following information will be published in the NCC Directory.
Click "Use From Above" to copy the information from above into the directory. Once copied, if there is information you want to change simply retype it. If you don't want specific information published then leave the field blank. Your occupation will also appear in the directory.
First Name:
Last Name:
Company:

Dream Job:
Address:
City:
State:
Zip:
Email:
Preffered Phone:
Fax:
Connection To Nebraska:
Bio:
More Info: Use this field for any information you'd like to provide about yourself to the NCC Directory.