| BERKSHIRE HILLS H.O.G. CHAPTER 2030 MEMBERSHIP ENROLLMENT FORM AND RELEASE CHAPTER NAME __________________________________________________________________________ MEMBER NAME __________________________________________________________________________ ADDRESS ________________________________________________________________________________ CITY ______________________________ STATE _____________________ ZIP ______________________ E-MAIL ADDRESS ________________________________________________________________________ PHONE NUMBER ___________________________ MEMBER NATL H.O.G. NUMBER _________________ EXPIRATION DATE OF NATIONAL H.O.G. MEMBERSHIP ______________________________________ I have read the Annual Charter for H.O.G. Chapters and hereby agree to abide by it as a member of this dealer sponsored chapter. - 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 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 occurring 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 the damage or injury is caused by negligence (except willful neglect). I understand and agree that all H.O.G. members and their guests participate voluntairily 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 or loss to my person or property which may result from my participation in H.O.G. activities and EVENTS(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 CONDUCTION SAID EVENTS(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 genereal 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 the Release and fully understant it and that I am not relaying on any statements or representations made by the "RELEASED PARTIES". MEMBER SIGNATURE _____________________________________________________________________ WITNESS ___________________________________________ DATE _______________________________ LOCAL DUES PAID $ _________________________________ DATE _______________________________ (Dues not to exceed maximun amount prescribed in, "Annual Charter for H.O.G. Chapters", as contained in the H.O.G. Chapter Handbook.) RETURN THIS FORM TO YOUR CHAPTER MEMREL.DOC (Rev. 11/24/97) |