Patriot Jeepers Inc. c/o Paul Dockery Treasurer 117 Country Street Lakeville, MA 02347 You will need to fill out this form, mail it in to the address above and then attend two Jeep runs, before you can become a member. Once you get approval to join please send in a check for $50 Payable to Patriot Jeepers.

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 31-33", tow hooks, fire extinguisher, first aid kit, tow strap, seat belts, CB radio, roll bar or steel top.