Route 66 HOG
Membership Application

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A separate form submission is required for each person requesting membership in Route 66 HOG Chapter #4060. In addition, you will be asked to sign a written release in person. Submission of this form grants you temporary membership so that you can start receiving your newsletters, but a written signature is needed for full membership into the Chapter.

Must be a member of the National HOG Association to be a member of the local HOG club
Member Name:
Address:
City:
State:
Zip:
Phone:
Email:
HOG Number:
Expiration Date:
Birthday:

THIS IS A RELEASE, READ BEFORE SUBMITTING

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 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 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 or loss to my person or property which may result from my participation in H.O.G. activities and "RELEASED PARTIES") shall not be liable or responsible for injury to me (including paralysis or death) or EVENT(S). 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 CONDUCTING SAID EVENT(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 general 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 submitting 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".

Last Updated: May 3, 2002

 
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