EMERALD COAST JEEPERS 

 

 Club Application


Membership fee $35 for new members and $25 for renewals. Payments collected on site only(at a meeting or club event); no mail-ins.
Funds collected are used for club decals (and other promotional items), website maintenance, club events and donations to charities, per club votes.   


CLUB APPLICATION

Please fill out our Club Application in order for us to promptly reply to your membership request. Note: This is for our records only and membership is only issued after receiving the yearly membership fee.

Upon receipt of the fee we will provide new members with a white windshield decal with club name or 2a7"X4" Club Decal (either white or black.)

New Membership dues must be paid in person (we want to meet you) 
Checks can be made payable to : Dave Gallant

First Name:
Last Name:
Address Street:
City:
State:
Zip Code: (5 digits)
Cell Phone:
Home Phone:
Can numbers be shared with other members? Both
No
Cell Only
Home Only
Do you want to participate in club discount from 4WD hardware? Yes     No   
Email:
Club Forum Screen Name:
How Often Do You Ride Offroad:
 Club Decals:  Choose One Windshield (White Only)   Or   Club Logo
 Club Logo Decal Colors White  Or   Black
Your Family:
Your Jeep:
Sponsor:
(Required if you do not have a Jeep)
Comments:
Administrative (Completed by club officer):
Membership fee received: 
Sticker issued:
Roster updated:
Website updated: 

              
Come Join Us, We Welcome All New Comer's