Flint Hills Jeep Club


Home About Us Events Trail Pics Members Join Us Links Forum Bylaws Contact the Club	For a Printer-friendly Version, click here for pdf version or word document version Club brochure available here FLINT HILLS JEEP CLUB C/O Colleen Strnad 1027 E. 1292 Rd. Lawrence, Kansas 66047 Phone: 785-842-5814 MEMBER INFORMATION SHEET NAME:_____________________________________________ SPOUSE:__________________________________________ ADDRESS:__________________________________________ CITY: ___________________________ STATE:________ ZIP CODE: _________ PHONE NUMBER: ______-______-__________ EMAIL: _________________________________ JEEP YEAR: __________MODEL ___________ SPECIAL EQUIP: WINCH ___ LIFTED ___ TOW POINTS (FT) ____ (R)____ CB ___ ROLL BARS (FT) ___ (R) ___ SEAT BELTS ____ FIRE EXT. ____ LOCKERS (FT) ____ (R) ____ TIRE SIZE ____ What type of activities would you like to see our Club conduct or get involved with:____________________________________ ________________________________________ How or who referred you to our Club:______________________________________ I understand that off-road vehicle operation can be hazardous, and accidents can occur which could result in either personal injury and or vehicle damage. I hereby agree to hold harmless all Officers, Representatives and Agents of the Flatlanders Jeep Club and acknowledge that I accept all risks involved in participation in activities sponsored by the Flatlanders Jeep Club. SIGNATURE: _____________________________________ DATE: ____________________ *If under 18 years of age, this form must also be signed by legal parent or guardian:* PARENT/GAURDIAN: _____________________________________ DATE: ___________________ ADDRESS & TELEPHONE Number ________________________________________ Club dues are $24.00 a year due on September 1^st. Dues are pro-rated depending on the month you join. Webmaster January 16, 2011 21:50

For a Printer-friendly Version, click here for pdf version or word document version

Club brochure available here

FLINT HILLS JEEP CLUB

C/O Colleen Strnad
1027 E. 1292 Rd.
Lawrence, Kansas 66047
Phone: 785-842-5814

MEMBER INFORMATION SHEET

NAME:_____________________________________________

SPOUSE:__________________________________________

ADDRESS:__________________________________________

CITY: ___________________________ STATE:________

ZIP CODE: _________

PHONE NUMBER: ______-______-__________

EMAIL: _________________________________

JEEP YEAR: __________MODEL ___________

SPECIAL EQUIP: WINCH ___ LIFTED ___
TOW POINTS (FT) ____ (R)____
CB ___ ROLL BARS (FT) ___ (R) ___
SEAT BELTS ____ FIRE EXT. ____
LOCKERS (FT) ____ (R) ____ TIRE SIZE ____

What type of activities would you like to see our Club conduct or get involved with:____________________________________

________________________________________

How or who referred you to our Club:______________________________________

I understand that off-road vehicle operation can be hazardous, and accidents can occur which could result in either personal injury and or vehicle damage. I hereby agree to hold harmless all Officers, Representatives and Agents of the Flatlanders Jeep Club and acknowledge that I accept all risks involved in participation in activities sponsored by the Flatlanders Jeep Club.

SIGNATURE:

_____________________________________

DATE: ____________________

If under 18 years of age, this form must also be signed by legal parent or guardian:

PARENT/GAURDIAN: _____________________________________

DATE: ___________________

ADDRESS & TELEPHONE Number ________________________________________

Club dues are $24.00 a year due on September 1^st. Dues are pro-rated depending on the month you join.

Webmaster January 16, 2011 21:50