Club brochure available here
C/O Colleen Strnad Phone: 785-842-5814
MEMBER INFORMATION SHEET
ZIP CODE: _________
PHONE NUMBER: ______-______-__________
JEEP YEAR: __________MODEL ___________
SPECIAL EQUIP: WINCH ___ LIFTED ___
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: ____________
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