Mid Ohio Jeepers Organization, LLC
www.midohiojeepers.com
Membership Application
P.O. Box 15, Kingston, Ohio 45644
[email protected]
Membership Dues $25/Yearly Starting 1/1/17
Applicants Name: _____________________________________________ Date: ________________
Membership Type: NEW (__) RENEWAL (__)
Date of Birth ___/___/___
(optional)
Name(s) of Family Members Joining _______________________________________________
Cell Phone: (____) _____-_________ Unlimited Text: YES (__) NO (__)
E-Mail Address: _______________________________________________________________
Home Address: _______________________________________________________________
City/State/Zip: ________________________________________________________________
Tell us about your Jeep (Year, Make, Model, and Color & Any Modifications):
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Trail Experience: Novice (__) Intermediate (__) Advanced (__)
Interests: Mud (__) Trails (__) Rocks (__) Pavement Only (__) Other: (__) explain: ____________ How
did you hear about MOJO? ____________________________________________________
Best way to get club information:
Cell Phone: (__)
Text Message: (__)
Facebook: (__)
Email: (__)
Snail Mail: (__)
Other: (__) explain: _____________________________
Would you consider an officer position with MOJO? YES (__) NO (__)
Signature: __________________________________________ Date: ______________________
Signature of MOJO Officer: _____________________________ Title: _______________________
Jeepers Enjoying Every Possible opportunity to JEEP!
Mid Ohio Jeepers Organization, LLC
www.midohiojeepers.com
RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT TO
MID OHIO JEEPERS ORGANIZATION, LLC
The PARTIES in this RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT are the Mid Ohio
Jeepers Organization, LLC club, its officers, directors, promoters, sponsors, and any employees (hereinafter
collectively referred to as the “Release’s”) and the UNDERSIGNED, his or her personal representative, heirs,
companions, and next of kin (hereinafter collectively referred to as the “Releasers”).
INCONSIDERATION of being permitted to participate in any event sponsored, promoted or directed by Mid Ohio
Jeepers Organization, LLC. THE UNDERSIGNED for himself or herself, and his other personal representative, heirs,
and next of kin, with knowing and willing consent of his or her PARENT OR LEGAL GUARDIAN as attested by
signature of the same if the UNDERSIGNED is below the age of 18 years, HEREBY RELEASES the Mid Ohio
Jeepers Organization, LLC, its officers, directors, promoters, sponsors, and employees and/or committee of all
liability to the undersigned, his personal representatives, heirs, and next of kin for any loss or damage on account of
injury to the undersigned or his property or resulting in the death of the undersigned whether caused by negligent act
or omission of Release’s or otherwise while the undersigned is for any purpose participating in such an event. It is
fully understood by each of the undersigned that there is some inherent risk associated with club events, including
damage to vehicles. In addition, the undersigned AGREES TO INDENMITY AND HOLD HARMLESS the ‘release’s
from any loss, liability, damage, or cost that they may incur due to such participation by the undersigned, whether
caused by the release’s negligence or otherwise and AGREES TO ASSUME FULL RESPONSIBILITY AND RISK for
any bodily injury, death, or property damage from the Release’s negligence or otherwise while the undersigned
hereby acknowledge and represents the following:
1)
2)
3)
4)
5)
That he/she has the foregoing Release Waiver and Liability and Indemnity Agreement.
That he/she shall at all times, while riding in a vehicle participating in club events, wear their respective
seatbelts, and
That the owner/driver certifies that he/she has inspected their vehicle and same is in good mechanical
condition, and
That the owner/driver has informed himself about the event and the trail(s) involved, either by prior
participation or by investigation into the event and/or trail.
That he/she releases the landowner of any responsibility of vehicle damage and/or bodily injury.
THE UNDERSIGNED HAS READ, COMPREHENED AND NOW VOLUNTATILY SIGNS THIS RELEASE AND
WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, and further agrees that no representations, statements of
inducements apart from the foregoing written agreement have been made.
Name of Driver: __________________________________________ Date: ______________________
Address: ___________________________________________________________________________
City/State/Zip: _______________________________________________________________________
Phone #: (_____) _____________________
Signature of Driver: ________________________________________________________________________
Name and ages of all passengers, Signature if over the age of 18 years:
1. ______________________________________________________________________________________ 2.
______________________________________________________________________________________ 3.
Jeepers Enjoying Every Possible opportunity to JEEP!
Mid Ohio Jeepers Organization, LLC
www.midohiojeepers.com
______________________________________________________________________________________ 4.
______________________________________________________________________________________
5. ______________________________________________________________________________________
Jeepers Enjoying Every Possible
Opportunity to JEEP!
www.midohiojeepers.com
Jeepers Enjoying Every Possible opportunity to JEEP!