Southern Jeeps Membership Application -- New Member $70 Renewal $59

PLEASE PRINT CLEARLY

Your Name:

 _____________________________________________ Check if over 18
Co-Member 1:

 _____________________________________________ Check if over 18
Co-Member 2:

 _____________________________________________ Check if over 18
Street Address:

 _____________________________________________
City/State/Zip:

 _____________________________________________
Home Phone:

 _____________________________________________
Cell Phone:

 _____________________________________________
Email Address:

 _____________________________________________
Forum Name:

 _____________________________________________
Jeep Year/Model:

 _____________________________________________
Jeep Description:

_____________________________________________


_____________________________________________
Off-Road Experience: (circle one)  Beginner    Intermediate    Advanced
This section to be filled out and signed by a Southern Jeeps official.
Vehicle Inspection Passed?

(  ) Yes  ( ) No

Trail Ready sticker applied?

(  ) Yes  ( ) No

Membership Dues Paid:

Date:

Amount:

Signed:
How Did You Hear About Us?  _____________________________________________________________

In order to join Southern Jeeps you must meet the following requirements:
1) be the registered owner of a 4wd Jeep vehicle 2) posses a valid drivers license 3) maintain car insurance as required by Georgia law 4) be at least 18 years of age.

Dues are $60.00 per family per year and are collected when you join. These dues also cover your membership in U.F.W.D.A. and S.F.W.D.A. Dues can be paid online using PayPal or by check made out to Southern Jeeps.

By signing below you state that you agree to the Southern Jeeps bylaws, trip rules and vehicle requirements.

Signed: ______________________________________   Date: _________________