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Baystate Jeepers, Inc. 2011 Membership Dues: $50.00 |
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Baystate Jeepers, Inc. 2011 Membership Dues: $50.00 |
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REGULAR MEMBERSHIP
APPLICATION, RELEASE FORM, |
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It is fully understood by the undersigned that there is some inherent risk associated with participation in Club events, including damage to Jeep® vehicles. In addition, the undersigned agrees to indemnify and hold harmless Baystate Jeepers, Inc., 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 Baystate Jeepers Club event. In addition, all vehicles must meet Baystate Jeepers, Inc. minimum requirements: Tire size 30"+, tow hooks, fire extinguisher, first aid kit, tow strap, CB radio. Please include a check for your annual dues when submitting this application. |
NAME (print)_______________________________________DATE OF BIRTH_____________
STREET ADDRESS_______________________________________________________________
CITY__________________________________STATE________________ZIP_______________
PHONE(H)________________________________(W)__________________________________
OTHER PHONE__________________________________________________________________
E-MAIL_______________________________________________________________________
SIGNATURE_____________________________________________DATE___________________
JEEP® VEHICLE INFORMATION:
MODEL_______________________YEAR_______________________COLOR_________________
TIRE SIZE (30" minimum)_____________________________________
HOW WOULD YOU LIKE TO RECEIVE YOUR NEWSLETTER? EMAIL POSTAL
MODIFICATIONS (IF ANY) :
SPECIAL SKILLS / CERTIFICATIONS USEFUL TO THE CLUB:
