Membership # (will be filled out by admin committee when You become full member)

Vehicle Make/Model/Year

Vehicle Registration

I acknowledge I have been made aware of the Outback 4WD Club rules and agree to abide by these rules on all functions/trips including following the reasonable directions of the trip leader. Additional to this, I acknowledge I am responsible for the passengers/additional people that accompany me on a trip/function

I accept that driving off road can be unpredictable, and that situations may arise where the direction of others may be required to negotiate or traverse an area. I understand that the people directing me may not have considered all aspects of the advice they provide and I agree to be responsible for the advice I choose to follow. In the event of my vehicle/passengers/equipment/self coming to harm/injury/death, I do not hold the Outback 4WD Club, it's committee, trip leaders responsible for said harm/injury/death

Do you hold a current First Aid Certificate?

• The applicant grants permission to the Outback 4WD Club Inc. to print details of my name, email address, phone number and if applicable any office I hold within the Outback 4WD Club Inc.
• I understand these details will be included on a membership list.
• The Executive and Committee will use membership lists for mail-outs and other club business.
• Memberships lists may be printed and distributed, or emailed to all members, or sponsors, where it is considered
appropriate by the committee.
• I acknowledge that the committee will take every precaution to ensure the security of my information.
• I accept that the club has no control over what happens to a membership list that may fall into the hands of a non-
member.

Ochre Card # (if none please type N/A)

Drivers License Number and State Issued

I hereby confirm that my vehicle is roadworthy, registered and have the mandatory insurance applied to the car upon registration. I also agree that if I do not have third party insurance and damage another members vehicle I am by law to provide my details to the other driver for insurance purposes.