Club brochure available here
FLINT HILLS JEEP CLUB
CITY: _____________________________ STATE:________ ZIP CODE: ____________
PHONE NUMBER: ______-______-__________ EMAIL: _______________________
JEEP YEAR: ________________ MODEL: ____________________________________
SPECIAL EQUIP: WINCH ___ LIFTED ___ TOW POINTS (FT) ____ (R)____
FIRE EXT. ____ LOCKERS (FT) ____ (R) ____ TIRE SIZE ____
What type of activities would you like to see our Club conduct or get involved with:
How did learn about, 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: _______________
PARENT/GUARDIAN: _____________________________________ DATE: ____________
DUES PAYMENT INFORMATION: Membership dues are $24.00 a year (September 1st - August 31st of the following year). Dues are pro-rated at $12.00 for those sending in their registration March – August. For membership to be complete, payment must be received with this form.
Webmaster November 3, 2013 15:11