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DirtCares4x4 Club Membership Application

Partnered with: Generosity Association

1. Personal Information

Full Name:

Date of Birth:

Age:

Phone:

Email:

Address:

2. Membership Type

Select Membership TypeMember Without Vehicle – $30/yearMember With 4x4 Vehicle – $30/year + Registration

3. Underage Membership (12–17)

I am applying for an underage membership

Guardian Name:

Guardian Contact:

Consent Form Attachment:

4. Vehicle Details (Only if registering a 4x4)

Vehicle Make/Model:

Year:

Registration Number:

4x4 Capable: YesNo

Insurance Status:

Roadworthy Cert: AttachedPending

Roadworthy File:

5. Vehicle Rental Interest

I am interested in renting out my 4x4 to other members

6. Terms & Declarations

I have read and agree to the Terms & Conditions

All provided information is true and accurate

I consent to sharing my data with DirtCares4x4 & Generosity Association

7. Signature

Type Full Name:

Date: