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Registrant #—HHN Use Only
1 Start Your Registration
* Hot Harley Nights is a charitable event. ALL proceeds benefit Make-A-Wish® SD.
Each rider and passenger must pay a registration fee to receive: (1) 2015 Hot Harley
Nights Short Sleeve T-shirt, (1) Parade Bandana, (1) Casino Run Card, (1) Event Pin,
(1) Drawstring Bag and misc. items from the HHN sponsors.
OPTIONAL INFORMATION (to be used in economic impact study)
Have you participated in Hot Harley Nights in the past?
yes
no
If so, how many years?
Rider Name
yes
Are you staying in a hotel in Sioux Falls during HHN?
If so, how many nights?
Passenger Name
no
Name of hotel?
Address
City State
Zip
PhoneEmail
2 Choose Your 2015 T-Shirt
Rider
Size
Color
Small
Medium
White
Large
XL
Choose Your 2015 T-Shirt
2XL
3XL
4XL
Passenger
Black
3 2015 Bike Show Registration
Number of HHN Registrations
• If you are not a registered HHN participant, bike show entries are $25 each.
Please indicate your non-registered entry in box 4.
• To enter multiple bikes, please add an additional $25 bike show registration fee.
Please indicate additional bike show entries in box 4.
Entry 2 Model
XL
2XL
3XL
4XL
at $10 (limit 1) = $
Additional Bike Show Entry
at $25 each = $
Bike Show: Non-registered HHN Participants
at $25 each = $
Number of Motorcycle Raffle Tickets
at $25 each = $
or Get Five Raffle Tickets For $100
at $100 each = $
Additional Parade Bandanas
at $10 each = $
Entry 1 Year
Entry 2 Year
(1 is included in $40 registration, must display in parade)
Entry 2 Class
at $40 each = $
Bike Show: Registered ($40) HHN Participants
Entry 1 Class
Entry 2 Make
Large
Black
Pre-registration must be received by June 19 and include
full payment. Review and sign waiver.
• Each $40 HHN registration fee allows (1) bike show entry at $10 each. Additional entries are $25 each.
Please indicate your registered entry in box 4.
Entry 1 Model
Medium
White
4 Payment For Registration
Friday, July 10, 2015, 6pm – 9pm at J&L Harley-Davidson
Entry 1 Make
Small
Size
Color
Sunday Morning Pancake Feed Tickets
Classes subject to change based on entries. We will notify participants of changes.
at $5 each =
$
Cash Donation Amount $
Antique: 1983 or older. All makes.
TOTAL AMOUNT DUE $
Sportster: XL Sportster models. Harley-Davidson V.I.N.
Street Stock Cruiser: Dyna, Softail, FXR or V-Rod equipped with bolt-on accessories,
with manufacturer paint and with all OEM sheet metal
Hot Harley Nights Motorcycle Raffle
A 2015 Fat Boy Lo will be given away
July 11, 2015 on the main stage.
Street Custom Cruiser: Dyna, Softail, FXR or V-Rod equipped with custom body panel or sheet
metal, also includes motorcycles with custom painted OEM body panels or sheet metal
Method of payment:
Street Touring: Touring models (both fairing and non-fairing) with OEM body panels and sheet metal, with manufacturer paint, equipped with bolt on accessories
Cash
Credit Card
Visa
Master Card
Custom Touring: Touring models (both fairing and non-fairing) with any sheet metal and body panels that are modified and are not OEM equipment
Check (please make payable to PPI)
Discover
American Express
Account Number:
Third Wheel: Trikes and sidecars. All makes. Vehicles with ‘steering wheels’ are not eligible.
Expiration Date:
Non Harley-Davidson, American Company: Non H-D American company
/
3 Digit CSV Code On Back of Card:
Name As It Appears On Card:
Non Harley-Davidson, All Makes: Non H-D foreign owned company
Custom Build: Custom assembled motorcycles, with no manufacturer V.I.N.
Card Holder’s Signature:
The undersigned (on my own behalf and on behalf of my heirs, personal representatives, successors and assigns), for and in consideration of J&L Harley-Davidson (“J&L”), Harley-Davidson, Inc. , (“H-D”), Philanthropy Promotions, Inc. (“PPI”),
Results Radio, KELO TV, Beal Distributing, Make-A-Wish South Dakota (“MAW”), Affiliated Sponsors and Contributors permitting me (or my child,
who is under 18) to
participate in Hot Harley Nights, and for other valuable consideration, the receipt and adequacy of which are hereby acknowledged, releases and discharges J&L, H-D, PPI, Results Radio, KELO TV, Beal Distributing, MAW, Affiliated Sponsors and
Contributors, their respective officers, directors, employees, agents and chapters from any and all claims and demands, rights and causes of action of any kind whatsoever which I (or my child) now have or later may have in any way resulting from
or arising out of or in connection with my participation in the motorcycle ride or other events.
Consent is also hereby given to J&L, H-D, PPI, Results Radio, KELO TV, Beal Distributing, MAW, Affiliated Sponsors and Contributors to use my (or my child’s) name, picture or portrait or likeness, writings or biographical information, audiotape or
videotape recordings and sound or silent motion pictures of me (or those of my child) in any media for editorial comment, educational, promotional and advertising purposes for the solicitation of contributions and for any other purpose in
furtherance of the objectives of J&L, H-D, PPI, Results Radio, KELO TV, Beal Distributing, MAW, Affiliated Sponsors and Contributors.
This Release extends to any and all claims I (or my child) have or may have against the released parties whether such claims result from negligence (except willful neglect) on the part of any or all of the released parties with respect to the motorcycle
ride and other events or with respect to the conditions (including but not limited to road, weather and traffic conditions), qualifications, instructions, rules, procedures and routes under which the motorcycle ride and other events are conducted, or
from any other cause. I am experienced in and familiar with the operation of motorcycles and fully understand the risks and dangers inherent in motorcycling. I am voluntarily participating in the motorcycle ride and other events and I expressly agree
to assume the entire risk of any accidents or personal injury, including death, which I might suffer as a result of my participation. The undersigned further agrees to waive all benefits flowing from any California stature or the stature of any other state
which would otherwise limit the scope of this release, 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.”
Hot Harley Nights 20th Anniversary July 9 – 12, 2015
THIS IS A RELEASE – READ BEFORE SIGNING By signing this release and ride participation form, I certify that I have read it and fully understand it and that I am not relying on any
statements or representations of any one released thereby:
Signature of RiderDate
Signature of PassengerDate
Print Name
Print Name
Address
City
Address
State
Zip
City
State
Zip
The event will be held rain or shine. The registration fee is non-refundable. Uncollected event packets may be picked up 10 days after the event or arrangements will be made to ship packets. Packets not collected after 30 days will be forfeited.
A Philanthropy Promotions, Inc. Event
5 Release and Ride Participation Release