Once completed all information will be kept strictly confidential.
The annual membership fee is $15.00. To be accepted as a member, this form must be completed in full. Requirements to join are:(1) You own a 4x4. (2) You must be 18 years of age or older. (3) There must be suitable tow points at both ends of the vehicle. (4) That you have a valid drivers license and your vehicle is insured.
Waiver And Attestation For Members On Trail Runs Organized By Northumberland Offroad
I have read, understand and agree to abide by the rules outlined below. I understand I am bound to these rules and that an infraction of these rules may result in further action by Northumberland Offroad. I understand and agree that Northumberland Offroad, its officers, and those acting on its behalf as well as trail landowners and others, cannot and will not be held responsible for any damages or injuries received that may or may not be incurred while on the trail run. I understand that I am to be held responsible for all actions of my guests, my vehicle and myself. I understand that if there are damages incurred that involve other vehicles, members and/or guests, the responsibility will be between myself and the party or parties involved and that these are not the responsibility of the Northumberland Offroad, or those acting on its behalf . I understand that by agreeing to this form I waive the right to any legal actions against Northumberland Offroad, including the people acting on its behalf. I hereby authorize Northumberland Offroad to use pictures or other media of my truck and/or its occupants to promote Northumberland Offroad in any way that it sees fit, which may include the use of media on websites, Tshirts and other apparel, pamphlets, business cards, or any marketing product.
First Name
Last Name
Address
City
Province
Postal Code
Home Phone
Email
Make Of Vehicle
Model Of Vehicle
Year Of Vehicle
Licence Plate #
Name of Insurance Company
By agreeing to these terms signifies that I have read, understood and agree with all text on this form, and that the information I have provided is accurate.
