Western Mass. 4x4 Online Membership Application

 

Pay online via PayPal after form submission.
Or mail a check after submitting your application:
Western Mass. 4x4
P.O. Box 49
Shelburne Falls, Ma. 01370
 
Fields marked * are required

Your Name *
Your Forum Name *
Your D.O.B. *
Your Address *
City/State/Zip *
Your Phone # + Area code *
Cell # + Area code
Your Email *
Emergency Contact *
Phone # + Area code *
Other Clubs/Organizations
Describe your vehicle(s)
Special skills or any comments

*Select Payment Type: Check PayPal

If using PayPal, enter your account email. You will be given the option to proceed to Paypal after submitting your application form.

PayPal Name

NOTE: PayPal dues are $52.00

I agree to pay the current annual dues of $50 to the Club as spelled out in the Club bylaws, and that I have read these bylaws and will adhere to them for the benefit of myself and the Club.

* I Agree I Disagree

Read the following, you will be asked to sign this before attending any Club events or activities:

Release and Indemnification agreement

I, the undersigned, fully understand that Western Mass. 4x4 (herein referred to as the Club)is an organization that participates in and sponsors events and activities that can be inherently dangerous. I acknowledge the risk of damage to my vehicle, injury or death to my guests, others, or myself. I agree to hold harmless the Club, its members, officers, directors, trail leaders, spotters, delegates, private property owners, sponsors, and supporters while participating in these events and activities. Furthermore I waive and release any and all rights and claims for damages for myself, my heirs, executors and administrators I have or may have against the Club. I will accept full responsibilty and liability for any damages or injury to my vehicle, my guests, others, or myself or property, which may result from any accident which occurs during Club events or activites.

 

When your are finished filling out the application, please ensure all information is correct and all fields are filled out, then click the Submit button.