PatriotJeepers,Inc 54 Edgmere Blvd Shrewsbury,Ma 01545 PatriotJeepers@gmail.com Find us on facebook at Patriot Jeepers (we have two pages, a members and Non members.) Before sending/emailing this form you must contact :PatriotJeepers@gmail.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 and or email above application. ,
Payable to Patriot Jeepers. You can use Paypal PatriotJeepers@gmail.com
members $50 Family membership $60 (30+30) |
REGULAR MEMBERSHIP, RELEASE FORM, |
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", tow hooks, fire extinguisher, first aid kit, tow strap, seat belts, FRS 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_______________________Sub model __________YEAR___________COLOR_________________
Example: Wrangler, Rubicon , 2005, Black
TIRE SIZE(32" minimum* 37" maximum* or metric =)_____________________________________
Open(O) Limted slip( LS) Locker(L) Front axle_______________ Rear axle__________________
Example: 3:73's, Dana 30 O