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: ____/____/____