Membership Application

Name___________________________________________________________________
Date of Birth____/____/____
Family members __________________________________________________________
Address_________________________________________________________________
Phone__________________________cell__________________________
E-mail address_________________________________________
Website______________________________________________
PNWJeep username_____________________________________

Experience level (off highway) web wheeler / beginner / moderate / hardcore(crazy)
Technical exp level don’t even own a socket set/ shadetree / mechanic / master fabricator

Vehicle Information:
Year_______make_________model________________________
Details (i.e. lift, lockers, axles, tires etc)
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Other Interests________________________________________________________________

Check if the following applies to you:

Want to get involved and help with trail runs ?
Willing to help with mechanical work on member’s rigs ?
Willing to hang out at Mike’s house and help paint his fence ?
Want to lend a hand at Meet & Greets ?
Willing to help with leading newbie runs and run instructional meets ?
Willing to be part of a skills database for sharing what we know ?

I give permission for my photo and vehicle to appear on the Montana Backroads 4x4 club website.