Application for Jeeps Membership

Wichita Jeeps Motorcycle Club
605 East 101st Street North, Park City KS 67147
www.jeepscycleclub.com

Application for Membership, Release and Waiver of Liability
The undersigned hereby makes application for membership in the Wichita Jeeps Motorcycle Club Inc. (herein after called WJMC I certify that I am at least 18 years of age and that I understand that the use and operation of a motorcycle, ATV or Go Kart may pose a risk of serious injury or death to the operator.

In consideration for becoming a member of the WJMC, I agree on behalf of myself and my heirs, executors, administrators, assigns and legal representatives to waive, release, promise not to sue and forever discharge the WJMC, its officers, board of directors, and other members (herein after called releasee) from and against any and all claims, causes of actions, demands or charges of whatsoever nature for property damage or personal injuries, including death, which I or any member of my family may sustain or incur while on the property of the WJMC by the operation of a motorcycle, or participant of a competitive event, even if caused in whole or in part by the negligence

The undersigned has read and voluntarily signed this release and waiver of liability, and further agrees that no oral representations, statements, or inducements apart from the forgoing written agreement have been made. The undersigned further acknowledges that they have read the rules of the WJMC on the reverse side of this application and will abide by them, and will reimburses WJMC for any cost due to their negligence.
Jeeps relies on volunteers for the success of the club. Please mark any skills you have below which you are willing to share with the club should the need arise

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Member Information
First Name
Last Name
Spouse / Domestic Partner Name
Please List All Dependent Family Members under 18 yrs and their DOB:
Dependent 1:
Dependent 2:
Dependent 3:
Dependent 4:
Dependent 5:
Dependent 6:
Address

Address

Street Address Line 2

CityState

ZIP
Place of Employment
Work Phone
Home Phone
Cell Phone
Email Address
(used for Club Newsletters and updates)
Would you like to receive occasional texts about Club news/updates to your cell phone. You can cancel any time by texting "stop"

YESNO
Signature

Clear
By applying for membership in the Wichita Jeeps Motorcycle Club Inc. I agree to abide by the following rules:
(Please check each box below to acknowledge that you have read each rule)
Every person admitted as a member of this club shall subscribe to the following obligations, which shall apply only to matters pertaining to the clubNon members may ride as a guest for a MAXIMUM of three times when the member is present. The guest must sign a waiver and pay the $10 per day guest fee. Race days excluded.Gate key MAY NOT be loaned to non members.Membership includes club privileges to spouse/domestic partner, and dependent children under the age of 18. Exceptions granted only per club approval.Members are allowed free admission to racing events for the member and the member's immediate family, only if membership card is stamped.All operators and passengers of all motorcycles, ATV's or Go Karts must wear a D. O. T. approved helmet. Other safety gear is highly recommended.The gate will be locked after leaving the club grounds: If the gate is open when a member enters, they will lock the gate when they come in. (With the exception of race days).Members and guests will ride on the tracks, NOT on the road, parking lot or pit area.No riding on any track that is being maintained or is being prepared for an event. No open riding when a race event is going on!No unleashed pets allowed on club grounds. They pose a hazard to the riders.Members will help make repairs around the club and will help at events.
Club meetings are at 8:00 PM the first Friday of every month, in Jeep's clubhouse. Visit us on the web at: jeepscycleclub.com or Facebook Jeeps Motorcycle Club.
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