ONLINE APPLICATION 1066 Membership Option * Full | £25.00 Associate | £7.50 Associate Member ONLY To become an Associate member, you must be sponsored by a Full member. In the box below, please provide the full name of your sponsor and their membership number. Name * First Name Last Name Date of Birth * MM DD YYYY Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Email * H.O.G.™ Membership Number Full member ONLY H.O.G.™ Membership Expiry Full member ONLY MM DD YYYY H.O.G.™ Membership Type Full member ONLY Life Full Associate DECLARATION - All of these boxes must be ticked to become a Chapter member. * I have read the Annual Charter for Harley Owners Group (H.O.G.™) Chapters and hereby agree to abide by it as a member of this dealer-sponsored Chapter. I recognise that while 1066 Chapter is chartered with H.O.G.™ it remains a separate, independent entity solely responsible for its actions. It is a H.O.G.™ requirement that the terms of the Declaration And Release are agreed to as a condition of 1066 membership. If any part of these terms should be invalid for any reason whatsoever under any applicable laws having jurisdiction over the subject matter of these terms, then that part shall be considered deleted from the terms and the rest of the terms shall remain valid and in full force and effect. The Chapter promotes safe riding on its rideouts. When I am a rideout participant, I agree to the following; I am responsible not only for my own safety but I also have a duty of care to fellow riders and all other road users; If I am considered by the Road Crew to be riding unsafely, I may be asked to leave the ride-out and will promptly do so if requested. In applying for membership or renewal thereof by means of this form I explicitly consent to the information contained herein being entered into and maintained on a secure database by 1066 Chapter and used for Chapter business only. It will not be divulged to any third party outside H.O.G.™ without your explicit consent. I must be a member in good standing of H.O.G.™ (where applicable) and, to continue to receive the benefits of 1066 Chapter membership, I must maintain my membership of H.O.G.™ (where applicable) at all times without interruption. If I fail so to do, my 1066 Chapter membership benefits will be terminated automatically and immediately without any refund of Chapter dues. I agree and understand that the declaration and release in Clause 1 above shall apply for the entire duration of my membership of 1066 Chapter, and should my membership lapse for any reason, I must submit a new membership form before being re-admitted. I accept that should there be any changes to the wording of the Declaration And Release, I may be required to submit a new membership form agreeing to the revisions in order to continue my Chapter membership. RELEASE - This box must be ticked to become a Chapter member. * I agree that the Sponsoring Dealer, Harley Owners Group (H.O.G.™), Harley-Davidson, Inc., Harley-Davidson Motor Company, 1066 Chapter and their respective officers, directors, employees and agents (hereinafter, the “RELEASED PARTIES”) 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 the 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 own 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 ticking this box, 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” Thank you!
