For participation in the Flatlanders 4x4 event, the undersigned hereby agrees to release and hold harmless any owners, sponsors, trail guides, workers, volunteers, and owners of both public and private land where the trail ride is held. This shall include officers, directors, agents, member clubs, and membership of the United Four Wheel Drive Association. The above shall also be released from any negligent act omission and shall also include release from any loss, damage, or cost incurred due to participation in this event.

The participant shall understand and assume all responsibility and risk for any PROPERTY DAMAGE, VEHICLE DAMAGE, INJURY, OR DEATH while participating in this event IN SIGNING THIS RELEASE, EACH PARTICIPANT HEREBY AGREES TO THE FOLLOWING:

(A) That the owner/operator certifies that he/she has inspected this vehicle and that the vehicle is in good working order and is STREET LEGAL WITH CURRENT INSURANCE COVERAGE ON THE VEHICLE.

(B) That each participant has informed himself/herself about the event and the trails involved in the event, attended the drivers meeting, and agrees to instructions/suggestions by trail leader/trail spotter on trouble areas or obstacles that may cause difficulty, and understands that you will be given two tries and then will be assisted with a tow strap or winch, so as not to cause a safety problem or hold up the rest of the trail participants.

(C) That each participant certifies that HE/SHE WILL TAKE NO ALCOHOLIC BEVERAGE/DRUGS ON THE TRAIL, NOR WILL HAVE PARTICIPATED IN ANY ALCOHOL/DRUG INTAKE ON THE DAY OF THE EVENT!!!

(D) Each participant also agrees not to carry any FIREARMS OR AMMUNITION on the day of the event.

(E) That he/she has read the foregoing Release and Waiver of Liability and Indemnity Agreement.

(F) THAT ALL DRIVERS AND PASSENGERS IN THE VEHICLE WILL WEAR SEAT BELTS DURING THE EVENT.

(G) WAIVERS MUST BE SIGNED BY ALL PARTICIPANTS -- FOR A PARTICIPANT UNDER THE AGE OF 18 YEARS, BOTH PARENTS, THE PARENT WITH LEGAL CUSTODY, OR THE MINORS LEGAL GUARDIAN MUST SIGN THIS RELEASE FORM AND WRITE THE WORD MINOR AND AGE NEXT TO THE MINOR'S NAME.

(H) ALL VEHICLES MUST HAVE EITHER A HARDTOP, OR IN THE EVENT OF A SOFT TOP VEHICLE YOU MUST HAVE A ROLL BAR, IF YOU ARE DRIVING WITHOUT A TOP YOU MUST HAVE A ROLL BAR!

I hereby forever release, acquit, discharge, indemnify and hold harmless the Flatlanders Jeep Club, their officers, of any club member/worker from any and all causes or causes of action, including personal injury, illness, death, property damage, cost, charges, claims, demands, and liabilities of whatever kind, name, or nature in any manner arising out of my participation during the Flatlanders 4x4 Event. Furthermore, I state on this ______ day of ____________, 19______, that if I willfully participate, either as a passenger or as the driver of a vehicle, I assume all risks, responsibilities, and liabilities for my conduct, as well as the conduct for the other passengers riding in my vehicle. In addition, I will hold harmless the officers and the Flatlanders Jeep Club as a whole. I have read and understand the above information.

Year / Type of Vehicle ________________________________________

Special Equipment:

Roll Bar ____,	Spare Tire ____,	Winch ____,	Seat Belts ____,
Front Tow Points ____,	Rear Tow Points ____,	Fire Extinguisher ____,	CB ____,
Hi-Lift Jack ____,	Front Locker ____,	Rear Locker ____

Name __________________________________________________

Address __________________________________________________

City ______________________________ State ______ ZIP ____________

Driver / Owner __________________________________________________

Driver's License Number _________________________ State _______________

Insurance Company __________________________________________________

Policy Number ______________________________

Will you be towing a vehicle on a trailer? ______Yes ______No

Fill out and return to:

Flatlanders Jeep Club P.O.Box 75 Ogden, KS 66517