American Legion Riders



 

 

  Application / Liability Waiver

American Legion Riders

Chapter 416

PLEASE PRINT                                      Encinitas, California

 

Last Name ___________________________________ First Name _____________________________

 

Road Name _________________ DOB________________ (Are you the) Rider ____ Passenger ____

 

Address: ___________________________________________________________________________

 

City ___________________________________________ State___________ ZIP _________________

 

Phone # Home (        ) __________________________ Cell # (        ) ___________________________

 

Email _____________________________________________________________________________

 

District # ____ Post # _____ Member # _______________________ Veteran __ Auxiliary __ SAL__

 

Bike Info: Make _____________ Model _______________ CC _____ License # _________________

 

Emergency Contact__________________________________ Phone (       )_____________________

 

RELEASE OF LIABILITY / MEMBER AGREEMENT – READ CAREFULLY BEFORE SIGNING

I certify that I am legally licensed to ride the motorcycle described above and that it has current registration and is properly insured; or that I am the spouse or registered domestic partner of a qualified member of the American Legion Riders Chapter 416, who is the licensed and registered owner of the motorcycle listed above and that it is properly insured. I agree that the American Legion Post 416 and or the American Legion Riders Chapter 416 shall not be responsible for damage to property or the any injury to any person, including myself, during any American Legion Riders activities, even where the damage or injury is caused by negligence (except the willful neglect of an officer of the American Legion Riders Chapter 416). I understand and agree that all American Legion Riders members and their guests participate voluntarily, at their own risk and expense in all American Legion Riders activities. I release and hold harmless the American Legion Riders Chapter 416 officers, the Department of California American Legion Riders, and the American Legion Post 416 for any injury or loss to my person or property which may result from my participation in any and all American Legion Riders activities. I understand that this means that I agree not to sue the American Legion Riders Chapter 416 or Post 416 officers, Department of California American Legion Riders, or the American Legion for any injury resulting to myself or my property in connection with any American Legion Riders activities.

 

I agree that the patch is the property of the Chapter 416 American Legion Riders and must be returned to the Chapter 416 American Legion Riders in good condition upon my resignation, suspension, or termination of membership in the American Legion Riders Chapter 416, the American Legion, American Legion Auxiliary, or the Sons of the American Legion. I also understand that the Initiation fee of $120.00 includes the first-year dues of $35.00, none of which is refundable.

 

I agree to abide by the By-laws of the American Legion Riders Chapter 416, the Constitution and Bylaws, rules and regulations of the American Legion Riders Department of California; and the Department in which I hold membership, and any lawful orders or directions of the officers of the American Legion Rider Chapter 416, given to me in the performance of their official duties.


Member Signature: _______________________________________________ Date _______________

 

Photo Release Signature: _________________________________________ Date________________

 

Membership Officer Signature: _____________________________________ Date _______________

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NEW_____ former Chapter/District_______ Called former Chapter/District on_____________________ RENEWAL______

Legion/AUX/SAL Card/Receipt__________________________ Application/Liability Waiver__________________________

CA Driver’s License/M1 Endorsed _____________Permit __________Permit Expiration Date________________________

Registration_________ Insurance Card_________ Amount Paid $____________Cash/Check #_______________________

Notes_________________________________________________________________________________________________