Baystate Jeepers, Inc. c/o Evelyn Howe, Secretary 5 Dalton Avenue Gloucester, MA 01930 2011 Membership Dues: $10.00

ASSOCIATE MEMBERSHIP APPLICATION, RELEASE FORM, AND WAIVER OF LIABILITY AND INDEMNITY

It is fully understood by the undersigned, that Baystate Jeepers, Inc. ("BSJI") Associate Membership is limited to persons at least 18 years of age. Associates may serve on a BSJI committee(s) of their choice and shall be eligible to vote at the "general" Club meetings. Associates will not be eligible to hold Office or Chair a committee. Applications shall be reviewed by the Membership Committee and Board of Directors prior to acceptance. Futhermore, it is fully understood by the undersigned that there is some inherent risk associated with participtation in Club events, including damage to Jeep® vehicles. In addition, the undersigned agrees to indemnify and hold harmless BSJI, its officers, and participants of any liability. The undersigned agrees to assume full responsibility for his/her actions and those of any minor(s) in their charge which could result in (but not limited to) injury, death, or property damage while participating in a BSJI Club event. It is further understood that an Associate may participate in any Club sponsored 'run' while accompanied by a regular member. The Associate shall not introduce or operate any vehicle, on a Club sponsored run, other than the single vehicle over which the regular member has responsibility and control. All participants must sign a trip roster/waiver of liability and indemnity before being permitted on a Club run. No rights or privilages other than those specifically stated herein and in the Club's By-Laws, shall be inferred or assumed.