Grass Roots Jeep Club Membership Application

Name *
Prefix
First *
Last *
Suffix
Email *
Address *
Street Address *
Address Line 2
City *
State / Province / Region *
Postal / Zip Code *
Country *
Phone *

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Jeep *
Screen Name

Grass Roots has a 2 Meeting 2 Trail ride requirement to be eligible for membership.

Membership Packages
Basic membership $50 entitles member to 1 vote, club shirt and any club give away
Family membership $75 entitles member and spouse to vote, club shirt and any club give away
Associate membership $40 NO REQUIREMENTS This level is for those that have show only Jeeps or are from long distances. Entitles member to 1 shirt and 1 vote when present.


Dues renewal are to be paid in Jan. with a 30 day grace period.

New member being voted in after mid year will pay 75% of dues.

Initial dues are to be paid in person after voted in.
(Except associate membership)

By submitting my application I understand that Grass Roots Jeep Club is an organization that sponsors a variety of activities for the benefit of its members. I am aware that many of the Club’s activities are inherently dangerous activities that involve the risk of serious injury and even death. I agree that I alone assume the risks involved in any such club activity and I absolve the club of any and all liabilities. In addition, and to the fullest extent allowed by law, I agree that I will not institute any lawsuit or other legal action against the Club, its members, officers, directors, delegates, instructors, agents, employees, representatives, sponsors, servants or assigns as a result of my participation or injury at any Club related activity. Nor will I voluntarily assist anyone else in the pursuit of any lawsuit or other legal action. I also agree to indemnify and hold harmless the Club, its members, officers, directors, delegates, instructors, agents, employees, representatives, sponsors, servants, or assigns from and against any and all claims, actions, suits, judgments, damages and costs, including reasonable attorney’s fees, that may result by reason of any suit or other legal action that I either commence or assist with as described in the preceding paragraph. This Release and Indemnification Agreement shall bind me, my distributees, heirs, executors, representatives, successors and assigns. I understand and acknowledge that the Club is acting in reliance upon the agreements made by me in this Release and Indemnification Agreement in order to extend to me the benefits of membership in the Club and were I not willing to abide by the terms of this document, such membership and opportunity to participate in Club related activities would not be extended to me.
Membership Level *
 Basic Membership 
 Family Membership 
 Associate Membership 
1st Shirt Size *
 Small 
 Medium 
 Large 
 X Large 
 XX Large 
 XXX Large 
2nd Shirt Size
( Family Only )
 Small 
 Medium 
 Large 
 X Large 
 XX Large 
 XXX Large