2018 National Rally Registration.                                            Just Print this Page with the ride WAIVER Mail it in.
              August 31 - September 2, 2018 
Cost of this Event                                                                                                                          Rider  $50.00                                                                                                                                      Passenger $40.00                                                                                                                              Pre-Registration cutoff date: 8-1-18

Print Below                                                       Print Below
Rider Name: __________________   Passengers Name: _________________ Address: _____________________  Address: ___________________
City: _________________                      City: _____________                                  State: _____ Zip Code: ________          State: _____ Zip Code: ______                      E-Mail: ______ ________________  E-Mail: ____________________                 Chapter Name: _________________ Chapter Name: __________________
Chapter Number: ___________             Chapter Number: ____________ 
                  Check One                                        Check One
Chapter Officers: 1st ____ 2nd ____      Chapter Officers: 1st ____ 2nd ____         State Officer what State: _______           State Officer what State: _______
Asst: State Officer what State: _____     Asst: State Officer what State: _____      National Officer Title: ________ National Officer Title: ______________

Rider: $50.00                                                                                                                          Passenger: $40.00                                                                                                                             Pre- Registration Include:                                                                                                         Event T-Shirts Per-Registration                                                                                              Event Patch per -Registration                                                                                                       

Registration Cost:                                                                                                                        Rider:-------------------------$50.00  = $ _____ Shirt Size:_____ + Patch                    Passengers: -----------------$40.00 = $ _____ Shirt Size: _____ + Patch                 Extras T-Shirts:   $25.00 X ____ = $ _____                                                                     Extras Patch:        $10.00 X ____ =  $ _____                                                                                           Total $  _____ & Check Number________

Mail this compete Registration with a check made out too.                                                                                                                                                          Leonard Space                                                                                                                           Address: 20845 South Diana Drive.                                                                                         City: Claremore, State: Oklahoma, Zip:74019 

               WAIVER OF LIABILITY AND INDEMNITY AGREEMENT
RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT


DATE: August 31/September 2/2018

IN CONSIDERATION
for being permitted to participate in the 2018 SCRC National Rally Event and Dice Run, sponsored by the Southern Cruisers Riding Club
THE UNDERSIGNED PARTICIPANTS:
1. HEREBY RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE
The Southern Cruisers Riding Club, its officers and members, along with any other sponsors and all of its holdings, and owners and lessees of premises used to conduct the event and each of them, their officers and employees, the dealers, officers, directors, management, officials and volunteers assisting in the event, the sanctioning organization or any subdivision thereof, grounds operators, grounds owner, officials, promoters, sponsors, advertisers; all for the purpose herein referred to as “releases,” from all liability to the undersigned, their personal representatives, assigns, heirs, and next of kin for any and all loss or damage, and any claim or demands therefore on account of injury to the person or property or resulting in death of the undersigned, whether caused by the negligence of the releases or otherwise while the undersigned is participating in the event;

2. HEREBY AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS the releases and each of them from any loss, liability, damage, or cost (including attorney’s fees) they may incur due to the presence of the undersigned participating in the event and whether caused by the negligence of the releases or otherwise.

3. THE UNDERSIGNED PARTICIPANTS
agree that while participating in this event, the use of alcohol or any substance which affects the ability to operate or control his or her vehicle or may be considered as hazardous to the health and safety of participants and spectators is strictly forbidden.

4. THE UNDERSIGNED AGREES that he or she will not use or operate any vehicle in violation or contravention of any City, County, State or Federal laws, statures, ordinances or regulation and shall be personally liable for all fines and penalties for traffic law violations.

5. HEREBY ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE
due to the negligence of releases or otherwise while participating in the event.

EACH OF THE UNDERSIGNED
expressly acknowledges and agrees that the foregoing release, waiver, and indemnity agreement is intended to be as broad and inclusive as is permitted by law of the State in which it is operated in and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

THE UNDERSIGNED HAS READ AND VOLUTARILY SIGNS THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT,
and further agree that no oral representations, statements or inducements apart from the foregoing written agreement have been made.

I understand and accept that in the course of my attendance at and participation in the Event, Film or Photographs may be taken, or illustration may be made of me and/or my personal property (including my Motorcycle). I acknowledge and agree that such film/photographs and/or illustrations may be used in any medium by the Southern Cruisers Riding Club and all its related entities and agencies for advertising and promotional purposes in any medium, without compensation to me.

Name: _____________________Address: _____________________    

State: _________________ City:__________Zip Code: __________

Signature: ______________________ Date: ____/____/____

Witness by: _______________________ Date: ____/____/____