Life Flight Network Membership

RattleSnake 4x4s has an exclusive Group Rate Membership with Life Flight Network, for flight insurance. While this was originally arranged on behalf of our club members, we allow friends of the club to enroll through the club and enjoy the same 25% discount. We recommend anybody that enjoys the outdoors consider a membership to Life Flight Network, you just never know when you might need air transport, and for a mere $50/yr per family, you can’t afford not to have it.

You can now apply to be a member online, by filling in the form below. No more waiting for our monthly meetings to get an application and sign up. Simply fill out the form below, then you can go to our online store and pay your dues and we’ll get you enrolled. Please understand this is a “Group Enrollment” and run by calendar year, member pay the club and the club makes on large payment. We renew each year in January, and there is no pro-rating, so hold off on that next gotta have part and protect yourself and your family now. Any clubs that are interested in doing the same can contact us for information, the requirements for a group are 10 or more members, if your group does not yet have 10, we can facilitate your membership until a time where you do reach 10 or more…

 




Please fill out this form as completely as possible so that all of your family members are covered by this flight insurance. Read all of the information by scrolling down to the bottom and Initial, Date, and be sure to check the box, before submitting your form.

 


 

MEMBER ENROLLMENT INFO

Your Name (required)

DOB (required)

Spouse/Domestic Partner Name

DOB

Address (required)

City (required) State (required) Zip (required)

Phone (required)

Your Email (required)

 


 

Additional Household Members:

Includes any dependents claimed on your tax return and elderly or disabled family members living in the same household.

HouseHold Member 1

DOB

Relationship

HouseHold Member 2

DOB

Relationship

HouseHold Member 3

DOB

Relationship

HouseHold Member 4

DOB

Relationship

HouseHold Member 5

DOB

Relationship

HouseHold Member 6

Relationship

DOB

 


 

DISCOUNT GROUP MEMBERSHIP RATE

$50 - 1 Year

Current LFN Member Y/N :

LFN ID Number (If Known)




 


 




 


 

AGREEMENT AND CONSENT

Initials Date

I Agree to the conditions listed above.

Check the box below to indicate agreement and that you are human.

 

Upon completion of Membership form (Don’t forget to check the Agreement box), please go to the Member’s Store and pay your dues.