AVIANO H.O.G. CHAPTER 9239 ENROLLMENT/RENEWAL FORM

1. Please write in CAPITAL letters. Membership prices and membership benefits are on the reserve. Areas indicated with a BLACK-BOX (∎) are minimal requirements – forms will be returned if not completed AVIANO H.O.G. CHAPTER 9239 ENROLLMENT/RENEWAL FORM FULL MEMBERSHIP ∎ Type of Full Membership ∎ Renewal (Existing Chapter Number) ____________________________  New ∎ Gender Male  Female Title ___________ ∎ First Name ____________________________ Initial ______________________________________________________ ∎ Surname ____________________________________________________________________________________________________________ ∎ Street _______________________________________________________________________________________________________________ ∎ Postcode _____ _____ _____ _____ _____ ∎ City ________________________________ ∎ State ________________________________ Tel. (Daytime) ____________________ (Work) _______________________ Email ________________________________________________ ∎ Current H.O.G. International Number _____________________________ ∎ Expiration Date______________________________________ ∎ Model ___________________________________ ∎ Type of Associate Membership ∎ Renewal (Existing Chapter Number) ____________________________  New ∎ Gender Male  Female Title ___________ ∎ First Name ____________________________ Initial ______________________________________________________ ∎ Surname ____________________________________________________________________________________________________________ ∎ Street _______________________________________________________________________________________________________________ ∎ Postcode _____ _____ _____ _____ _____ ∎ City ________________________________ ∎ State ________________________________ Tel. (Daytime) ____________________ (Work) _______________________ Email ________________________________________________ ∎ Current H.O.G. International Number _____________________________ ∎ Expiration Date______________________________________ ASSOCIATE MEMBERSHIP

2. MEMBERSHIP BENEFITS H.O.G. AVIANO CHAPTER9239 ENROLMENT/RENEWAL FORM (pg 2) 1. Admittance to all general membership meetings (GMM) held once a month. 2. The purchase of a H.O.G. patch at cost through the Chapter. 3. The eligibility to purchase and wear the chapter rockers and/or chapter patch, after meeting chapter requirements. 4. You will receive publicity of local rides, events and chapter sponsored activities. 5. Road side help if you should happen to break down in the local area through the chapter’s emergency contacts. 6. The ability to hang out with a great group of people with the same interest as you as well as pick up on some great ideas for your bike. 7. Planned chapter rides as well as impromptu rides throughout each month (check the chapter schedule of events). 8. Information of safety tips and any recalls for Harley-Davidson, as well as tech advance on some of the “how to” for bike repairs. 9. All of this for just $12 per year full or associate membership. LIABLITY RELEASE (read before signing) I agree that the Sponsoring Dealer, Harley Owners Group (H.O.G.), Harley-Davidson Inc., Harley-Davidson Motor Company, Chapter 9239 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 and resulting from acts or omissions occurring during performance of the duties of the “Released Parties”, 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 on 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 RESULTING DAMAGE TO MYSELF OR MY PROPERTY ARISING FROM, OR IN CONNECTION WITH, THE PERFORMANCE OF THEIR CHAPTER DUTIES IN SPONSORING, PLANNING OR CONDUCTING SAID EVENT(S). 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’S SIGNATURE: __________________________________________________________ DATE: _____________________________ WITNESS’S SIGNATURE: __________________________________________________________ DATE: _____________________________ LOCAL DUES PAID: $_______________________________________ DATE: ________________________________