CC Riders Application &
Liability Release
Member Name:
___________________________ ______ __________________________
First
MI Last
Member Name:
___________________________ ______ __________________________
First
MI Last
Address:___________________________________________________________________________
City:
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
right 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 with your check payable to:
CC Riders
PO BOX 4941
Greenwood Village,
CO. 80155-4941
DUES: Please check
one
__ $25.00 per
operator
__ $40.00 per couple
(operator and passenger)
For Club
Business Only
Cash ____ Cash Amount
_______
Check No. _______
Check Amount _______
Copy received: ___ Driver’s license(s) ___ Proof of insurance
Roster ______ Card ______ Rocker _______ Ride
Book ________