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 Flint Hills Jeep Club and acknowledge that I accept all risks involved in participation in activities sponsored by the Flint Hills 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 No. ________________________________________ Club dues are $24.00 a year from September 1st —August 31st of the following year.Dues are pro-rated at $12.00 for a partial year only from March 1st or any other subsequent month through August 31st. Webmaster August 16, 2012 22:06

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 Flint Hills Jeep Club and acknowledge that I accept all risks involved in participation in activities sponsored by the Flint Hills 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 No. ________________________________________

Club dues are $24.00 a year from September 1st —August 31st of the following year.Dues are pro-rated at $12.00 for a partial year only from March 1st or any other subsequent month through August 31st.

Webmaster August 16, 2012 22:06