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2015 1ST ANNUAL - RIDE FOR THE SQUAD Motorcycle Ride and Fund Raiser to benefit the Hoyt Hardin, Austin Augustine and Dylan Bieber Scholarship Fund — MOTORCYCLE RIDE REGISTRATION FORM --Saturday April 11, 2015 – Registration/Check-In Opens at 8:30 a.m. Participant(s): Rider Name________________________________________________________________________ Addresss:__________________________________________________________________________ City:_________________________________ State:________________ Zip Code:_______________ Phone:_______________________________ E-mail:______________________________________ Emergency Contact:______________________________________________________________________ Shirt Size: Small Medium Large X-Large XX-Large XXX-Large [Circle Size Needed] Passenger Name: ________________________________________________________________________ Addresss:__________________________________________________________________________ City:_________________________________ State:________________ Zip Code:_______________ Phone:_______________________________ E-mail:______________________________________ Emergency Contact:_____________________________________________________________________ Shirt Size: Small Medium Large X-Large XX-Large XXX-Large [Circle Size Needed] $25 for Driver/$15 for Passenger Please Read Carefully Before Signing – Must be signed prior to participating in ride. RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT In consideration of the acceptance of my entry in this event, I do for myself, my heirs, executors, administrators and assigns, hereby give up, RELEASE, and forever DISCHARGE in advance my rights to sue or make any claim for damages due to negligence or carelessness against Officers, Directors, Members, and Agents; other Promoters, Sponsors and their employees; and all organizations and their employees conducting or connected with the 2015 1ST ANNUAL RIDE FOR THE SQUAD for injury to person that I may suffer, including crippling injury or death, while participating in the event and while upon event premises. I AM AWARE THAT MOTORCYCLING CARRIES A SIGNIFICANT RISK OF SERIOUS PERSONAL INJURY, DEATH AND/OR PROPERTY DAMAGE. I know the risks of danger to myself, my minor child (if present) and my property while participating in the event and while upon the event premises and, relying upon my own judgment and ability. I ASSUME ALL SUCH RISKS OF LOSS and hereby agree to reimburse all costs to, and to forever HOLD HARMLESS and INDEMNIFY, all persons and entities identified above, generally and specifically, from any and all liability for death and/or personal injury or property damage in any way from my participation in this event. Rider Signature:_____________________________________________Date:____________________________ Passenger Signature:_________________________________________ Date: ____________________________ Please note: “Ride For Squad” on Check Mail Entry with Check or Money Order to: Beverly Eddy Ride For The Squad 135 Hill Ridge Drive Wetumpka, Alabama 36092 For more information please visit http: / /www.rideforthesquad.com Sponsorship Funds can be paid online at www.rideforthesquad.com, or applicable form mailed as instructed above – A receipt will be generated for each donation.
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