CC Riders Application & Liability Release

(Please print information)

Member Name: ___________________________ ______ ________________________

First MI Last

Member Name: ___________________________ ______ ________________________

First MI Last

Address: ________________________________________________________________

City: _________________________________State:______________ Zip:___________

Home Phone: _________________________E-Mail: ___________________________

O.K to list personal information in club access only roster? (Y/N)_______

Motorcycle(s)

Year: _____________________________________________ 

Make:_____________________ ________________________

Model: ____________________ ______________________

Engine: ____________________________________________

Colors: ____________________________________________

Liability Release

I (We) agree the sponsoring group, CC Riders, and the respective officers, directors, employees and agents, as well as the sponsoring individual of any quest, property owner of any property CC Riders has permission to use, the ride leader, the rider leader’s team of any ride in which I (we) may participate, (hereinafter the “Released Parties”), shall not be liable or responsible for injury to me (us) (including paralysis or death) or damage to my (our) property during any CC Riders activities even where the damage or injury is caused by ordinary negligence.

I (We) understand and agree this release shall be construed in the broadest sense allowed by law and this is a knowing and intelligent waiver of any and all rights which I (we) might have to the fullest extent allowed by law. I (We) understand and agree all CC Riders members and guests participate voluntarily and at the individual’s sole risk in all CC Riders activities and I (we) hereby knowingly and intelligently agree to assume all risks of injury and damage arising out of or related to conduct of such activities.

I (We) release, indemnify and hold harmless the “Released Parties” from any injury or loss to my (our) person or property which may result from my (our) participation in CC Riders activities and events, and agree to indemnify the “Released Parties” for any cost incurred in defending against any action I (we) might bring in violation of the terms of this release including, but not limited to, costs and reasonable attorney fees. I (We) further agree to waive all benefits flowing for any specific state statue now in effect or subsequently enacted, to the full extent allowed by law, which would negate or limit the scope of this release and indemnification agreement.

I (We) hereby understand this means I (we) agree not to sue the “Released Parties” for any injury or damage to myself (ourselves) or my (our) property resulting from, or in connection with, any CC Riders activities or events.

I (We) represent to the club I (we) have had training and/or experience and I (we) attest I (we) am (are) skilled in the operation of a motorcycle and riding in a group.

By signing this document I (we) certify I (we) have fully read this Release and completely understand it. I (we) am (are) not relying on any statements or representations made by the “Released Parties” and that I (we) knowingly and intelligently execute this release which shall be effective until revoked in writing by me (us) prior to any injury, damage or possible cause of action accruing.

Print member name: __________________________________

Signature: ______________________________ Date: ___________

Print member name: __________________________________

Signature: ______________________________ Date: ___________

Mail application/liability release, copy of your Driver’s License(s) and Proof of Insurance card(s) with your check payable to:

CC Riders Motorcycle Club

P. O. Box 7484

Broomfield, CO 80021-0025

DUES: Please check one

$25.00 per operator ____ $40.00 per couple (operator and passenger) ____

For Club Business Only

Dues Received: Cash ____Cash Amount _______Check No. _______Check Amount _______

Copy received: Driver’s license(s) ___ Proof of insurance ___

Distributed to member(s): Card(s) ______ Rocker(s) _______