BRIDGEPORT, CT. CHAPTER OF H.O.G.
MEMBERSHIP ENROLLMENT FORM AND RELEASE

RENEWAL_______ MEMBER SINCE_______ NEW_______

MEMBER NAME____________________________________________________________________
ADDRESS____________________________________________________________________________
CITY ___________________________________STATE ___________ZIP__________________
TELEPHONE NUMBER __________________E-MAIL ADDRESS________________________
MEMBER H.O.G. NUMBER_______________________ H.O.G. EXPIRATION DATE_____________
 

WOULD YOU LIKE THE ABOVE INFORMATION ( NAME, ADDRESS TELEPHONE AND INTERNET
ADDRESS) LISTED IN THE ANNUAL CHAPTER DIRECTORY?        YES_____    NO_____ 

I have read the Harley Owners group chapter for local chapters and hereby agree to
abide by it as a member of this dealer sponsored local chapter

I recognize that while this 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 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 "RELEASEDPARTIES") 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, 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 EVENT(S).
I UNDERSTAND THAT THIS MEANS THAT I AGREE NOT TO SUE THE "RELEASED PARTIES" FOR ANY INJURY OR  DAMAGE 
TO MYSELF OR MY PROPERTY RESULTING FROM, OR IN CONNECTION WITH, ANY H.O.G. OR H.O.G. CHAPTER
ACTIVITIES OR EVENTS.

                                  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 thisRelease 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 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".


 

MEMBER SIGNATURE_____________________________________________________          DATE_________________

WITNESS  SIGNATURE____________________________________________________           DATE_________________

 

 LOCAL DUES PAID $_____________(LOCAL DUES ARE CURRENTLY $20.00 PER YEAR)
(Dues not to exceed maximum amount prescribed in, 'Charter for Local Chapters', as
contained in the H.O.G.Chapter handbook.)

*** RETURN THIS FORM WITH A CHECK FOR $20.00 MADE OUT TO BRIDGEPORT (CT) CHAPTER, INC.',
A COPY OF YOUR CURRENT H.O.G. MEMBERSHIP CARD AND VALID INSURANCE CARD TO:
ATTN:  Bridgeport Ct. Chapter of H.O.G.
155 Research Drive
Stratford, Ct. 06615

TYPE OF PAYMENT: Cash______ Check______: Check No.____________