| CHAPTER NAME: ___________________________________________________________________ |
| MEMBER NAME: ____________________________________________________________________ |
| ADDRESS: _________________________________________________________________________ |
| CITY: ______________________________ STATE: ___________ ZIP_______________-_________ |
| PHONE NUMBER: ___________________________________________________________________ |
| NATIONAL MEMBER H.O.G. NUMBER: ________________________________________________ |
| EXPIRATION DATE OF NATIONAL H.O.G. MEMBERSHIP: ________________________________ |
| I have read the Harley Owners Group Charter for local chapters and herby agree to abide by it as a member of this dealer sponsored local chapter. |
| I recognize that while my Local Chapter is chartered with H.O.G., it remains a separate, independent entity solely responsible for its actions. |
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| 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, employees 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, even where thee 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 risks of injury and damage arising out of the conduct of such activities. I release and hold the "RELEASED PARTIES" harmless from any injury 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 AND INJURY OR DAMAGE TO MYSELF OR MY PROPERTY RESULTING FROM, OR IN CONNECTION WITH, ANY H.O.G. or H.O.G. CHAPTER ACTIVITIES OR EVENTS. |
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I further agree to waive all benefits flowing from any state statue 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:
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| 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: _________________________ |
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as contained in the H.O.G. Chapter Handbook) |
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