Mason 132 Fourth Annual Motorcycle Dice Run and Car Show August 30th 2015 9605 Colvin Blvd. Niagara Falls, NY Registration and Wavier Participants agree to follow a designated course and have a participant card stamped at locations before completing the Run and turning in the participant card at the ending location of Marlboro Inn. All cards must be turned in by 5:00 p.m. on the day of the event. This event is not a race; speed limits and normal safety rules for the safe operation of a motorcycle should be followed at all times. The operators, Free and Accepted Masons Lodges and The Rapids Theatre assume no liability for any damage or injury that results from participation in this event. As a participant in the above-named event, I hereby, and for (my) heirs, executors, administrators, assigns, and all legal guardians, WAIVE AND RELEASE ANY AND ALL RIGHTS AND CLAIMS Of; ANY NATURE, FOUNDED IN WHOLE OR IN PART UPON ANY TYPE OF NEGLIGENCE , that (I) (my rider) may have against any Free and Accepted Masons Lodges and the Marlboro Inn. Their directors, officers, employees, agents, chapters, assignees, licensees, volunteers and any cooperating entities, their representatives, heirs, executors, administrators, successors, and assigns (the "Released Parties") arising out of or resulting from any and all injuries or damages of any nature, including death, which I may suffer. While taking part in the event or any activities connected with the event. This Release extends to any and all claims I have or may have against the Released Parties, whether such claims result from negli-gence on the part of any or all of the Released Parties with respect to the event or any related activities or with respect to the condi-tions (including but not limited to road, weather, and traffic conditions), qualifications, instructions, rules, procedures and routes un-der which the event and related activities are conducted, or from any other cause. (I AM) (MY PASSENGER IS) EXPERIENCED .IN AND /Familiar WITH THE OPERATION OF MOTORCYCLES AND FULLY UNDERSTAND THE RISKS AND DANGERS INHERENT IN MOTORCYCLING. (I am) (my rider) voluntarily participating in the event and I expressly agree to assume sole responsibility for the safe and successful operation of my motorcycle, and to accept the entire risk of any accidents or personal injury, including death, which (I) (my rider) might suffer as a result of my participation in the event. I further understand that (I) (my rider) assume(s) all risks in participating in the event. By signing this document, I certify that I have read this, document and fully understand it, and that I am not relying on any statements or representations of any of the Released Parties. This document shall be binding upon me, my (my rider) heirs, Executors, administrators and assigns and all legal guardians Name Address City State Phone For Car Show E-mail Year Model Make Car Show $15.00 Signature I will pay with check or cash the day of the event Zip Color Passenger $10.00 Submit or print this form and mail with payment to Niagara LaSalle Lodge # 132, 9605 Colvin Blvd NF, NY 14304 Reset Form Rider $15.00