CHAPTEREVENT MEMBERSHIP ENROLMENT FORM AND RELEASEFOR FORM FOR ADULTS RELEASE ADULTS Name of Event(s): Date: Location: Retailer: – THIS IS A RELEASE, READ BEFORE SIGNING – The undersigned (on my own, and on behalf of my heirs, personal representatives, successors, and assigns), for and in consideration of the opportunity to participate in a “Ride”, “Poker Run”, “Rally”, “Field Meet” or “Activity” and any other related H.O.G.® event or activity (hereinafter, the “ACTIVITIES”) associated with, sponsored and/or conducted by Harley Davidson Michigan Inc., Harley-Davidson Motor Company Inc., its subsidiaries and affiliates, Fred Deeley Imports Ltd., Harley-Davidson Owners Group® of Canada Ltd., or my Chapter, the Retailer, event, or location named above and any other organizers, sponsors, officials, and volunteers; and their respective directors, officers, shareholders, employees, partners, affiliates, agents, representatives, successors, and assigns (all being collectively referred to hereafter as “RELEASED PARTIES”) hereby irrevocably release and forever discharge the RELEASED PARTIES from any and all claims, demands, damages, rights, actions, causes of action, suits, debts, contracts, interest, costs, expenses of any kind whatsoever, howsoever arising, directly or indirectly, which I now have, or later may have against the RELEASED PARTIES, whether known or unknown, in law or in equity, in any way resulting from, arising out of, or in connection with my participation in any and all of the said ACTIVITIES. Without limiting the foregoing, this Release extends to any and all claims I have or may have against the RELEASED PARTIES whether or not such claims result from strict liability or negligence on the part of any or all of the RELEASED PARTIES, or from any action or inaction on my part, during the ACTIVITIES or any claims with respect to the conditions, qualifications, instructions, rules, or procedures under which the ACTIVITIES are conducted or from any other cause. I UNDERSTAND THAT THIS MEANS THAT I AGREE NOT TO SUE ANY OR ALL OF THE RELEASED PARTIES FOR ANY INJURY RESULTING TO MYSELF OR OTHERS, OR MY PROPERTY OR THE PROPERTY OF OTHERS, ARISING FROM, OR IN CONNECTION WITH SAID ACTIVITIES. In consideration of my being allowed to participate in the ACTIVITIES, I agree to indemnify and hold harmless the RELEASED PARTIES from any and all liability, claims, causes of action, demands, damages, or any other forms of relief which might be made against any or all of the RELEASED PARTIES whatsoever, howsoever arising, directly or indirectly out of or in consequence of my attendance at or participation in the ACTIVITIES. I hereby warrant and represent that: in the event that I am operating a motorcycle during the ACTIVITIES, I am experienced in and familiar with the operation and riding of motorcycles and I hold a valid motorcycle operator’s licence (Ontario Class “M or M2” licence or provincial equivalent), or in the event that I am a passenger on a motorcycle during the ACTIVITIES, I am experienced in and familiar with being a passenger on motorcycles; I fully understand the risks and dangers inherent in motorcycling; and I am the age of majority in the Province or Territory that the ACTIVITIES are located in. I am voluntarily participating in the ACTIVITIES and I expressly agree to assume the entire risk of any accident, personal injury, including death, property damage, or any other harm which I may suffer as a result of my participation in the ACTIVITIES, notwithstanding any prevailing weather, road or other conditions, and any other factors which may impact or affect in any way the conduct of the ACTIVITIES or my participation therein. ©2014 H-D or its affiliates. Harley Owners Group, H.O.G., H-D, Harley, Harley-Davidson and the H.O.G. logo are among the trademarks of H-D U.S.A., LLC. BY SIGNING THIS RELEASE, I CERTIFY THAT I HAVE READ THIS RELEASE AND THAT I FULLY UNDERSTAND IT, AND THAT I AM NOT RELYING ON ANY STATEMENTS OR REPRESENTATIONS MADE BY THE RELEASED PARTIES. I FURTHER UNDERSTAND AND AM AWARE THAT BY SIGNING THIS RELEASE I AM WAIVING CERTAIN SUBSTANTIAL LEGAL RIGHTS WHICH MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS AND ASSIGNS, AND I MAY HAVE AGAINST THE RELEASED PARTIES EITHER INDIVIDUALLY OR COLLECTIVELY. AS A MEMBER OR GUEST OF THE CHAPTER, I AM FULLY AWARE THAT THERE IS A “ZERO ALCOHOL TOLERANCE POLICY”. I UNDERSTAND AND ACCEPT THAT IN CONSUMING ANY ALCOHOL DURING ANY CHAPTER RIDING EVENT OR ACTIVITY, IT WILL NULLIFY MY COVERAGE UNDER THE CHAPTER LIABILITY INSURANCE POLICY. I ACKNOWLEDGE THAT I AM SOLELY RESPONSIBLE AND ACCOUNTABLE AS AN INDIVIDUAL FOR MY ACTIONS, AND HEREBY AGREE TO ADHERE TO THIS POLICY DURING THE COURSE OF ANY CHAPTER RIDING EVENT AND ACTIVITY IN WHICH I AM A PARTICIPANT. PARTICIPANT Signature Print Name Address City Prov./State P.C./Zip Date For emergency purposes: Contact Tel. # Emergency Contact ©2014 H-D or its affiliates. Harley Owners Group, H.O.G., H-D, Harley, Harley-Davidson and the H.O.G. logo are among the trademarks of H-D U.S.A., LLC.
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