CHAPTER NAME ("Chapter") ______________________________________________________________
MEMBER NAME _____________________________________________________________
CITY________________________ PROV. _________________ POSTAL CODE ______________
PHONE# ____________________ NATIONAL H.O.G.® MEMBERSHIP#__________________
EXPIRATION DATE OF NATIONAL H.O.G.® MEMBERSHIP _______________________
RETAILER ("Sponsoring Retailer") SPONSORING RETAILER ADDRESS AND TELEPHONE#
I wish to receive communications from Harley-Davidson Owners Groups of Canada Ltd., Deeley Harley-Davidsons Canada, and the Sponsoring Retailer regarding Harley-Davidson9 Brand products, services, programs, contests, and promotional offers. I also agree to be contacted for market research purposes. Harley-Davidson Owners Groups of Canada Ltd. is seeking such consent on behalf of itself, Deeley Harley-Davidson Canada, and the Sponsoring Retailer. You may withdraw your consent at any time from Harley-Davidson Owners Groups of Canada Ltd. and Deeley Harley-Davidsons Canada by contacting the Privacy Officer at 604-273-5421 OR 13500 Verdun Place, Richmond, B.C. V6V 1V2, or from the Sponsoring Retailer by contacting the Sponsoring Retailer at the address and phone number provided above.
□ Yes, I do wish to receive communications and be contacted for research purposes.
□No, I do not wish to receive communications and be contacted for research purposes.
I have read the Annual Charter for H.O.G.® Chapters and hereby agree to abide by it as a member of the Chapter.
I recognize that while the Chapter is chartered with H.O.G.®, it remains a separate, independent entity solely responsible for its actions.
- THIS IS A RELEASE, READ BEFORE SIGNING -
I, the undersigned, (on my own, and on behalf of my heirs, personal representatives, successors, and assigns), for and in consideration of the opportunity to be a H.O.G.I'!) Chapter member and participate in H.O.G.® Chapter events and related activities do hereby irrevocably release and forever discharge the Sponsoring Retailer, Harley-Davidson Michigan Inc., Harley-Davidson Motor Company Inc., its subsidiaries and affiliates, Fred Deeley Imports Ltd., Harley-Davidson Owners Groups of Canada Ltd., or the Chapter, 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"), from any and all claims, demands, damages, rights, actions, causes of action, suits, debts, contracts, interest, costs, expenses of any kind whatsoever, which I now have or later may have against the RELEASED PARTIES howsoever arising, directly or indirectly, whether known or unknown, in law or in equity, in any way in any resulting from, arising out of, or in connection with my participation in any and all H.O.G.®, Chapter events or activities (the "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 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
©2014 H-D or its affiliates. Harley Owners Group, H.O.G. H-D. Harley, l-larley-Dav1dson and the H.O.G. logo are among the trademarks of H-0 U.SA, LL.C.
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 license (Ontario Class "M or M2"license 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, damage to property, 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.
CONSENT TO USE AND DISCLOSURE OF PERSONAL INFORMATION
I recognize and understand that Harley-Davidson Owners Groups of Canada Ltd. is collecting my personal information on behalf of itself, Deeley Harley-Davidson• Canada, and the Sponsoring Retailer (collectively the "Users"), that any and all Users may disclose my personal information among them, and that my personal information may be used by the Users for purposes connected with my membership of the above-named Chapter. I further recognize that the Users may also use my personal information to better understand their Customers/members and improve their products and services. I acknowledge that a file containing my personal information will be maintained in a hard or electronic file at the Users' premises and will be used for the purposes identified above, or other purposes with my consent or as permitted or required by law. I further acknowledge that authorized employees and
Representatives of the Users will have access to my information as necessary to perform their job functions. I also give my permission for the free use of my likeness and any comments I have made, for publicity of any kind, in any media, promotion, or advertisement without compensation.
BY SIGNING 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. 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 OF A 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.
MEMBER SIGNATURE ______________________ LOCAL DUES PAID$ DATE _________
(Dues not to exceed maximum amount prescribed in, "Annual Charter for H.O.G.® Chapters", as contained in the H.O.G.* Chapter Handbook.)