CHAPTER ENROLLMENT FORM FOR 2012
CHAPTER MEMBERSHIP
ENROLLMENT FORM AND
RELEASE
MEMBER NAME
__________________________________________________
ADDRESS
______________________________________________________
PHONE #
________________ HOG #
_________________ (EXP)________
E-MAIL ADDRESS:
______________________________________________
As a member of HOG I do ( ) do not ( ) mind if other members of the Club are given my phone number or my e-mail address.
I recognize that while this Chapter is chartered with HOG, it remains a
separate, independent entity solely responsible for its actions.
-THIS IS A RELEASE, READ BEFORE SIGNING-
I agree that the Sponsoring Dealer, Harley Owners Group (H.O.G.), Harley-Davidson, Inc., Harley-Davidson Motor Company, my Local Chapter and their respective officers, directors, and agents (hereinafter, the “RELEASED PARTIES”)shall not be liable or responsible for injury to me (including paralysis or death) or damage to my property during any H.O.G. or H.O.G. Chapter activities and resulting from acts or omissions occurring during the performance of the duties of the Released Parties, even where damage or injury is caused by negligence (except willful neglect). I understand and agree that all H.O.G. members and their guests participate voluntarily and at their own risk in all H.O.G. activities and I assume all risk of injury and damage arising out of the conduct of such activities. I release and hold the “RELEASED PARTIES” harmless from any injury or loss to my person or property which may result from my participation in H.O.G. activities and event(s). I UNDERSTAND THAT THIS MEANS THAT I AGREE NOT TO SUE THE “RELEASED PARTIES” FOR ANY INJURY OR RESULTING DAMAGE TO MYSELF OR MY PROPERTY ARISING FROM, OR IN CONNECTION WITH, THE PERFORMANCE OF THEIR CHAPTER DUTIES IN SPONSORING, PLANNING, OR CONDUCTING SAID EVENT(S).
WAIVER OF RIGHTS UNDER STATE STATUTES
I further agree to waive all benefits flowing from any state statute which would negate or limit the scope of this Release and Indemnification Agreement including, but not limited to, Section 1542 of the California Civil Code, which provides:
“A general release does not extend to the claims which the creditor does not know or suspect to exist in his favor at the time of executing the release, which if known to him must have materially affected his settlement with the debtor.”
By signing this Release, I certify that I have read this Release and fully understand it and that I am not relying on any statements or representations made by the “RELEASED PARTIES.”
MEMBER
SIGNATURE________________________________________________
WITNESS________________________________________ DATE ___________
LOCAL DUES PAID $
____________________ DATE_____________________
Cash ____________
Check # ________________
RETURN THIS FORM ALONG WITH FEE TO A CHAPTER OFFICER