NOVA Jeepers Membership – Join Now – Northern Virginia Jeepers Association

Membership Type

Individual – $30.00
Family – $50.00

Screen Name

Make sure this matches your forum username EXACTLY. If you don’t have a forum username, please register one first, then complete this form.Otherwise your membership status will not automatically be applied

Name

First

Last

Phone

Email

Confirm Email

2nd Family Member – Screen Name

Make sure this matches your forum username EXACTLY. If you don’t have a forum username, please register one first, then complete this form.Otherwise your membership status will not automatically be applied

2nd Family Member Name

First

Last

2nd Family Member Phone

2nd Family Member – Email

Address

Address Line 1

Address Line 2

City

State

Zip Code

Jeep Year

Jeep Model

Jeep Model Code (TJ, ZJ, FC, etc.)

Jeep Model Other

If model not listed, please specify

State Insured

Jeep Condition & Insurance

I agree

I agree to keep my vehicle(s) in a safe driving, and operating condition as required for the state in which it is registered. I shall have the minimum state requirement for coverage of insurance for each vehicle I own, and that I intend to use at Club events.

Membership Code

I agree

As a member of the Northern Virginia Jeepers Association (NOVA Jeepers), I have read, understand and agree to abide by the Membership Code of Responsibilities. The Member Code of Responsibilities are located in section 1.6 of the Northern Virginia Jeepers Association Bylaws.

Forum Rules

I agree

As a member of the Northern Virginia Jeepers Association (NOVA Jeepers), I have read, understand and agree to abide by the Forum Rules.

Other Association Club Affiliations

No Thanks! – $0.00
Virginia 4WD Association (VA4WD) – $15.00
Blue Ribbon Coalition (BRC) – $15.00
Virginia 4WD Association (VA4WD) and Blue Ribbon Coalition (BRC) – $30.00

Novajeepers is a member club of Virginia 4WD Association (VA4WD). Novajeepers members may elect to opt into VA4WD when they annually register with Novajeepers. Novajeepers will send in your dues and process membership with VA4WD as a part of the member club registration process. VA4WD is affiliated with the Blue Ribbon Coalition (BRC), members may additionally choose to opt into this affiliation at the time of registration. By selecting either option you agree to the additional fees and acknowledge that you understand the benefits and requirements pertaining to these memberships as outlined on the Novajeepers forum. On the forum your membership image will display additional badges for each affiliation.

Release and Waiver of Liability Agreement

I agree

For consideration, including permission to voluntarily participate in any event sponsored, promoted, or directed by the Northern Virginia Jeepers Association (NOVA Jeepers). And intending to be legally bound, the undersigned, for himself/herself, his/her personal representatives, heirs, assigns, and next of kin: Hereby releases Northern Virginia Jeepers Association, its officers, members, trail guides, sponsors of NOVA Jeepers, owners and lessors of premises used to conduct the events of all liability for any harm or damage however caused including any act or omission, directly or indirectly the result of any event. It is understood and accepted by each of the undersigned that there is inherit risk associated with all events, including but not limited to bodily injury, and vehicle damage, that is assumed by each participant. In addition, the undersigned, his/her personal representatives, heirs, assigns, and next of kin understand that while attending some events, the chance of being photographed is possible, and that agrees any/all photographs taken by the club officers or their designees can be used for purposes to promote the organization and its events. In signing this Release and Waiver of Liability Agreement, each of the undersigned hereby acknowledges and represents that he/she has read, understood, and agrees to the Release and Waiver of Liability Agreement in its entirety, and each signature is voluntary.

Total

$0.00

Payment

Card

Name on Card