Jeeping Mid Rivers Membership 2017-2018 Application
Please fill this form out entirely and correctly.
Dues for the 2017/2018 year are $20.00.

There are 3 ways to pay:
Cash or check at a meeting,
Paypal - Sent to jeepingmidrivers@gmail.com (please use send money to a friend option)
Sending check to the following address:
Jeeping Mid Rivers
Attn: Gene Reid
830 Whitcomb Woods Drive
Troy, MO 63379

Please make checks out to Jeeping Mid Rivers.

Is this a new or renewal application?
Required
Name
Your answer
Address
Full address please!!
Your answer
Email
Your answer
Birthdate
Please enter as mm/dd/yyyy
Your answer
Phone Number
Please enter as xxx-xxx-xxxx
Your answer
Year and Model of Jeep
Your answer
Is this a joint membership with a spouse?
Required
Spouse's Name
Your answer
Spouse's Phone Number
Please enter as xxx-xxx-xxxx
Your answer
Spouse's Email
Your answer
Children's names and ages
Your answer
Emergency Contact (different from spouse if joint membership)
Your answer
Emergency Contact Phone Number
Please enter as xxx-xxx-xxxx
Your answer
Describe your trail experience and preferred trail types/ratings
Your answer
How did you hear about Jeeping Mid Rivers?
Your answer
What color Decal would you like?
Once your application has been approved and the dues paid, you will recieve a welcome packet via mail. in this packet will be your club ID card, information on JMR, and a club decal. If you would like additional decals, they are $5.00 and may be purchased at any club meeting.
Digital signature of primary applicant
I understand the inherent risks of off-roading and agree not to hold Jeeping Mid Rivers, its coordinators or members liable for any accident or injury that may occur during any official Jeeping Mid Rivers event. I will participate in trail runs and attempt any obstacle at my own risk.
Your answer
Dues Paid
For Coordinator Use only
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