Austin Jeep Exclusive Membership Application

Date

Name

First

Last

Address

Street

City

State

Zip

Phone

Cell

Email

This will also be your AJE website User ID

Facebook Profile

For invitation to AJE Private Facebook group

Jeep

Year

Model

Tire Size

Front

Rear

None

Lockers

Offroad Experience

Beginner

Intermediate

Advanced

Accommodation Preference

Tent Camping

RV Camping

Hotel/Motel

Have you ever been a member of another off-road club?

Yes

No

Please provide club name(s)

Do you have an emergency medical training?

Yes

No

Please describe your training

Do you have any mechanical experience?

Yes

No

Would you be willing to teach a class for members?

Yes

No

Would you be willing to serve as an officer?

Yes

No

Would you be willing to serve on a committee?

Yes

No

T-Shirt Size

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