Our hobby comes with high potential for mishaps, so RattleSnake 4x4s partnered with the Life Flight Network to create a registration group that is open to anyone wanting coverage for air ambulance services. Save a few bucks and sign -up on our group, we forward forms and money (we don’t make a dime) to Life Flight Network and in about 72 hours from their receipt you are covered, so it pays to do this before you actually need it. We like to call it cheap insurance for the whole household in the event of a needed flight, and recommend folks seriously consider this in addition to our club membership.

Apply to get your Life Flight Network Membership online, by filling in the form below. Simply fill out the form below, then pay your dues with the links below. Memberships are by calendar year and expire on 12/31. Because the club has to write one big check at the end of January for the full amount of the group, there will be two links, If you follow the instructions all will work out perfectly. We want to get everyone on a January subscription, to make it easier on everybody.

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About The Applicant

Applicant Name *

First

Last

Applicant Date of Birth *

Please enter your birthdate, i.e. 01/01/2000 simple text

Address *

Address Line 1

Address Line 2

City

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Zip Code

Phone *

Email *

Household

Family Status *

• Single
• Married
• Single w/Dependents
• Married w/Dependents

How Many Household Members? *

• 1
• 2
• 3
• 4
• 5

Spouse/Partner Name *

First

Last

Spouse/Partner Date of Birth *

Please enter your Spouse/Partner's birthdate, i.e. 01/01/2000 simple text

Spouse or Partner? *

• Spouse
• Partner

Household Member 1 Name *

First

Last

Household Member 1 DOB *

Please enter your Household Member's birthdate, i.e. 01/01/2000 simple text

Household Member 2 Name *

First

Last

Household Member 2 DOB *

Please enter your Household Member's birthdate, i.e. 01/01/2000 simple text

Household Member 3 Name *

First

Last

Household Member 3 DOB *

Please enter your Household Member's birthdate, i.e. 01/01/2000 simple text

Household Member 4 Name *

First

Last

Household Member 4 DOB *

Please enter your Household Member's birthdate, i.e. 01/01/2000 simple text

Household Member 5 Name *

First

Last

Household Member 5 DOB *

Please enter your Household Member's birthdate, i.e. 01/01/2000 simple text

LFN Membership Form Type *

• New
• Renewal
• Update Info
• Current Mbr - Add to RS4x4s Group

The choices here can be confusing, so allow me to explain them. New, Renewal & Update Info are to identify why you are filling out the form (New membership or a Renewal. Update info - this is for those whose family has changed in number, as LFN needs to know all in the household they are covering. Finally Current Mbr - Add to RS4x4s Group - This is for folks who currently have a LifeFlight Membership, but are not part of our RattleSnake 4x4s Group. This is important if somebody already has a membership and wants the payment to be made through our Group, as all of our memberships are billed in January of each year.

LFN Member Number *

If you currently have a LFN Member number place it here.

LFN Acknowledgement *

• I/We Acknowledge

This application is valid through 12/31 this year. Please contact the Membership Office for an updated application if this form is expired. New member benefits take effect 72 hours after receipt of completed application and payment. Life Flight Network transports patients based on medical need, not membership status. Medicaid beneficiaries should not apply for membership. Aviation services provided by Life Flight Network and Jackson Jet Center. DISCOUNT GROUP MEMBERSHIP RATE of $78/Year.

Signature *

Clear Signature

Please sign your form and then submit

Date Name Name

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Payment

If you sign-up in January use the following link (image below) to start a subscrition that will automatically renew each year (no more chasing you down for renewals).

If you sign-up any other time of year use this link (image below) for a one-time payment, so that upon renewal in January we can get you on a subscription.