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HJC - THERN WANDERERS

HIMACHAL JEEP CLUB (HJC) MEMBERSHIP APPLICATION

Initiation Membership = Rs. 10000/-
Renewal Membership = Rs. 10000/- (Annual basis)

(Membership includes only 1 person and 1 jeep per application)

Fill out this form along with cheque, cash or e payment (GooglePay, Paytm). Or bring the form and payment to monthly meeting.

Member Information

Name:

Address:

Email ID:

Date of Birth:

Reference (Self/HJC):

Emergency Contact Information

Name:

Relationship:

Address:

Mobile Phone:

Allergies and Medical Conditions (List appropriately below)

Blood Group:

Any Allergy / Medical Condition:

Vehicle Description & Information

Registration Number of Vehicle:

HJC Membership includes:

Club Membership Card,
Club Membership Windshield Decal and Apparels,
Monthly Trail Rides Eve. & Activities,
Jeep Event Calendar,
Club Sponsored Events (Club cover some/all event costs),
Participation in Charity/Social Events,
Membership Directory and Discount Programs with HJC Affiliates.

Membership Release & Waiver of Liability & Indemnity Agreement

The undersign hereby agrees to indemnify and hold harmless the Himachal Jeep Club,
its members of any loss, liability, damage, or cost they may incur while attending
any club event/function.

This includes any outside event attended and/or sponsored by HJC,
as well as any family members, friends, or guests brought to any event.

Member assumes sole responsibility for their actions as well as
family members and guests brought to any event.

Member Signature Required(Write your name here for self attested)

Date

Club Directory Information Release: Please check one

Yes, Publish my contact information in the FIX directory and social link accountsNo, Thank you, Keep my contact information private.

Approved:

HJC#:

Thank You

Thank you. Your form has been submitted successfully.

Submission Failed

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get in touch

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Full Name *

Phone number *

Email address *

Your Message *

get in touch

We’re Here for You

Phone

+91 9418091033

email

himachaljeepclub@gmail.com

Himachal Jeep Club

Rajgarh Rd, above URS SUPERMARKET, Solan, Himachal Pradesh 173212

HJC - THERN WANDERERS

HIMACHAL JEEP CLUB (HJC) MEMBERSHIP APPLICATION

Initiation Membership = Rs. 10000/-
Renewal Membership = Rs. 10000/- (Annual basis)

(Membership includes only 1 person and 1 jeep per application)

Fill out this form along with cheque, cash or e payment (GooglePay, Paytm). Or bring the form and payment to monthly meeting.

Member Information

Name:

Address:

Email ID:

Date of Birth:

Reference (Self/HJC):

Emergency Contact Information

Name:

Relationship:

Address:

Mobile Phone:

Allergies and Medical Conditions (List appropriately below)

Blood Group:

Any Allergy / Medical Condition:

Vehicle Description & Information

Registration Number of Vehicle:

HJC Membership includes:

Membership Release & Waiver of Liability & Indemnity Agreement

The undersign hereby agrees to indemnify and hold harmless the Himachal Jeep Club,
its members of any loss, liability, damage, or cost they may incur while attending
any club event/function.

This includes any outside event attended and/or sponsored by HJC,
as well as any family members, friends, or guests brought to any event.

Member assumes sole responsibility for their actions as well as
family members and guests brought to any event.

Member Signature Required(Write your name here for self attested)

Date

Club Directory Information Release: Please check one

Yes, Publish my contact information in the FIX directory and social link accountsNo, Thank you, Keep my contact information private.

Approved:

HJC#:

Thank You

Thank you. Your form has been submitted successfully.

Submission Failed

Something went wrong. Please try again.

contact

We’re Here for You

We’re Here for You

Phone

email

Himachal Jeep Club

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+91 9418091033

himachaljeepclub@gmail.com

Himachal Jeep Club