2012 Rover-Landers of BC Membership Application Form - Details

Please provide us information about yourself and your Land Rovers.

Member Details
*Fields marked with an asterisk are required
Last Name*
First Name*
Address*
City / Town*
Province / State*
Postal Code*
Home Phone* (Include area code)
Work Phone (Include area code)
Fax (Include area code)
Birth Date
Email Address*
Sticker Yes
No, not needed
Your Land-Rover(s):
Year Model Colour Features
I would like to help:
Phone-out members
Be an executive
Assist newsletter		 Off-road event planning
Other event planning
Other
I would like to take part in the following activities:
Heavy off-roading (possibility of body damage: large rocks, narrow trails)
Light off-roading (little possibility of body damage: gravel road, ditches)
On-road events (eg. road rallies, Whistler All British Run)
Show and shine events (eg. Founders' Day, Vandusen ABFM, Portland ABFM)
Indoor events (eg. dinners, meetings, information sessions, slide shows, club displays)

Terms and Conditions

I, the undersigned, hereby acknowledge:
1. The above information is true,
2. I am at least nineteen (19) years of age,
3. I have adequate insurance on my vehicle for off-road use,
4. That Rover-Landers of BC, its officials or directors and members, will not be held liable for any damage or injuries that may occur during an event or related activity organized by the club.
5. While every reasonable precaution is taken, members attend club events at their own risk and are expected to act in a safe, responsible manner.
6. Clicking the "Continue to Step 2" button to the right is equivalent to my signing of agreement to these terms.
When you click the Submit Details button below you'll be taken to step 2, payment for your membership.