PatriotJeepers,Inc  54 Edgmere Blvd Shrewsbury,Ma 01545  PatriotJeepers@gmail.com 

Find us on facebook at Patriot Jeepers 

Before sending/emailing this form you must contact :PatriotJeepers@aol.com  

to ask any ?'s you may have.*Trip info is done by e-mail so you will want to  get on our email list.

 Please fill out this form, mail or e-mail  it in to the address above and then you must attend one Jeep run,

before you can become a member. Once you get approval to join please send in a check for $50

Payable to Patriot Jeepers. You can use Paypal PatriotJeepers@gmail.com 

NEW Members $50       Renewing members $40 

REGULAR MEMBERSHIP, RELEASE FORM,
AND WAIVER OF LIABILITY AND INDEMNITY

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 PatriotJeepers 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 PatriotJeeper Club event. The undersigned has also read and complied with the bylaws. In addition, all vehicles must meet PatriotJeepers minimum requirements: Tire size 32"-37" *See below, tow hooks, fire extinguisher, first aid kit, tow strap, seat belts, CB radio, roll bar or steel top.

NAME (print)_______________________________________DATE OF BIRTH_____________

STREET ADDRESS_______________________________________________________________

CITY__________________________________STATE________________ZIP_______________

PHONE(H)______________________(W)___________________(Other)__________________

*E-MAIL_______________________________________________________________________

SIGNATURE_____________________________________________DATE___________________

JEEP® VEHICLE INFORMATION:

MODEL_______________________YEAR_______________________COLOR_________________

TIRE SIZE(32" minimum* 37" maximum* or metric =)_____________________________________

*Update 2017 See bylaws     No 35" tires with a Dana 35.

Open(O) Limted slip( LS) Locker(L)  Front axle_______________ Rear axle__________________

Example: 3:73's, Dana 30 O