NWA Membership Application

Name*

First NameLast Name

Phone Number*

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Address

Street Address

Street Address Line 2

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Postal / Zip Code

Email*

example@example.com

Jeep Name*

Jeep Info.*

Driver's License Number and State*

Insurance Company*

I am interested in (check all that apply):

Are you a new or returning member?

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Name

First NameLast Name

Name

First NameLast Name

Name

First NameLast Name

Name

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Name

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Waiver

I certify that I hold a valid driver's license and that my Jeep is registered in the state where I reside. I have the legally required liability insurance for my Jeep. I understand that there are risks associated with driving 4x4 Jeeps on roads and trails, including, but not limited to vehicle damage and/or personal injury. I understand that I will operate my Jeep in accordance with all state laws.

As a club member, I will handle myself and my Jeep with respect, and I have read, signed, and understand NWAs liability waiver. I am responsible for anyone who drives my Jeep and they are covered on my insurance policy.

Release and Waiver of Liability and Indemnity Agreement

to Northshore Wrangler Association, LLC (NWA)
In consideration of being permitted to participate in any and all the events sponsored, promoted, or directed by NWA for the time period of June 1, 2022, to May 31, 2023, the undersigned for him or herself, his or her personal representatives, heirs, assigns, and relatives, HEREBY RELEASE the Northshore Wrangler Association, LLC and its respective officers, members, directors, promoters, sponsors, employees, owners, managers, lessors and their agents, hereafter referred to as Releasees, of any and all liability to the undersigned, whether caused by the negligent act or omission of RELEASEES or otherwise, while the undersigned is for any purpose participating in such event, whether the participation is a volunteer or paid worker, a contestant, or observer or present in any other capacity. It is fully understood by each of the undersigned that there is some inherent and open and obvious risks associated with some of the events and activities sponsored by the Northshore Wrangler Association, LLC., including by not limited to damage to vehicles and property, personal injury and/or death. IN ADDITION, the undersigned AGREES TO INDEMNIFY AND HOLD HARMLESS the releasees from any and all loss due to property damage, liability damage, or costs RELEASEES could incur due to such participation by the undersigned, whether caused by Releasees’ negligence or otherwise and the undersigned further AGREES TO ASSUME FULL RESPONSIBILITY AND RISK for any bodily injury to him or herself, to their parties, date, and/or all property damage resulting from Releasees acts, negligence or otherwise, while the undersigned is participating in any event organized and or sponsored by the Northshore Wrangler Association. LLC

PURSUANT TO LA.R.S.9”2795.4 A MOTORIZED OFF-ROAD VEHICLE SPONSOR OR MOTORIZED OFF-ROAD VEHICLE PROFESSIONAL IS NOT LIABLE FOR AN INJURY TO OR THE DEATH OF A PARTICIPANT IN A MOTORIZED OFF-ROAD VEHICLE ACTIVITY RESULTING FROM THE INHERENT RISKS OF THE MOTORIZED OFF-ROAD VEHICLE ACTIVITY. THE UNDERSIGNED ACKNOWLEDGES THAT THEY HAVE BEEN PROVIDED A COPY OF LA.R.S.9:2795.4 WHICH THEY HAVE READ AND HAVE AN UNDERSTANDING THEREOF.

In signing this release, each of the undersigned hereby acknowledges and represents the following:

That he or she has read and understood the foregoing Release and Waiver of Liability and Indemnity Agreement.
That he or she shall always while riding in a vehicle participating in events, wear their respective seat and shoulder belts.
That the owner/driver certified that he/she has inspected their vehicle being used in the event and they certify that same is in good mechanical condition and that said vehicle is in compliance with all applicable state laws, including the required liability insurance.
That the owner/driver agrees to assume full responsibility for his/her passengers in his/her vehicle and ensures that all passengers have signed this release form.
That the owner/driver has liability insurance on the vehicle driven by them as required by the state in which it is registered, and the owner/driver agrees to assume full legal liability for any damage or injury which may be caused by the owner/driver’s acts whether by negligence or otherwise.

A waiver must be signed by all participants. For a person under the age of 18, both parents, the parent with legal custody, or the minor’s legal guardian must sign a release form.

Driver Name*

First NameLast Name

Passenger 1

First NameLast Name

Passenger 2

First NameLast Name

Passenger 3

First NameLast Name

Passenger 4

First NameLast Name

Signature: By signing this application for membership to Northshore Wrangler Association, I agree to the rules/bylaws of the club and understand I can be removed from the page and/or club for violation of club rules/bylaws.

Date

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One Year MembershipEnter description

$30.00 Quantity

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NWA Membership Application

Additional Drivers

Waiver

Release and Waiver of Liability and Indemnity Agreement