Nutmeg State 4X4 : Membership Form

Nutmeg State 4x4

Enrollment Form - 2001

Name:______________________________________________________________________________________

Address:____________________________________________________________________________________

___________________________________________________________________________________________

City:_____________________________________________________ State:______ Zip Code:_______________

Telephone:_________________________ E-Mail:___________________________________________________

$50.00 New Annual Membership Includes:

Monthly (in season) Trail Runs

Membership in EC4WDA - Region D

News Letters

Vehicle Sticker

Special Events

Please Make your check payable to "Nutmeg State 4x4"

Minimum Vehicle Requirements

Four Wheel Drive (with Low Range)

At least 29" tires (235/75R15 or 30 x 9.50R15 or better)

Required Equipment:	Recommended Equipment:
Full Size Spare Tire & Jack	Spare Fluids (oil, coolant, and brake)
Tow Hooks/Points Front & Rear	Spare Parts (Brake line, hoses, ect...)
Tow Strap	Tools, Jumper Cables, ect...
C. B. Radio	Shovel, Axe, Saw, ect...
Fire Extinguisher	Traction Device (e.g. Locker)
First Aid Kit	Winch

In consideration for the foregoing, I, for myself, my heirs, executors and administrators, waive and release any and all rights and claims for damages I have or may have against the East Coast Four Wheel Drive Association and/or the Nutmeg State 4x4 Club (hereby referred to as"Association" and "Club"), and any and all trail leaders, and Association and/or Club officials, Association and/or Club officers, private property holders, participating sponsors and supporters for all claims of damages, demands, actions, whatsoever in any manner, as a result of my participation in the Nutmeg State 4x4 Club and Club events. I attest and verify that I will be responsible for any injury to myself or anyone riding in my vehicle and that I will be responsible for any damage to said vehicle. Further, I certify that my vehicle meets the safety requirements for legal operation in the State of Connecticut and for the rules of the Nutmeg State 4x4 Club (including integral metal top or roll bar). I have read the trail descriptions and difficulty ratings and I believe my equipment and driving experience are appropriate for the trails I have chosen. I agree to use proper seat belts for myself and my passengers while my vehicle is moving on the trails or going to and from the trails.

Signature:___________________________________________

Date:_______________________________________________

Print, Complete, & Send Check to:

Doug Sciullo

Nutmeg State 4x4

149 Armand Road

Ridgefield, CT 06877

Member Rig Survey

Member Name:___________________________________________________________

Year / Make / Model:______________________________________________________

Engine:_________________________________________________________________

Transmission:____________________________________________________________

Transfer Case:____________________________________________________________

Axle / Locker:____________________________________________________________

Suspension / Body Lift:____________________________________________________

Tires: __________________________________________________________________

Winch: _________________________________________________________________

Misc. Equipment: _________________________________________________________

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