Allies Angel Ride

Saturday, May 31, 2014

All proceeds to benefit children and familes of the Southern Tier of NY Motorcycle Ride
Ride begins and ends at: Hickories Park; 359 Hickories Park Road, Pavilion 5, Owego, NY Ride day registration and packet pick-up starts at 8:00 a.m. Ride leaves at 9:00 a.m. sharp Pre-registration is $25; Event Day Registration fee is $30 and includes Allies Angels kickstand puck, handlebar streamers and meal ticket. Additional riders are $10, including meal ticket; additional meal tickets for non-riders are $10. 2014 T-shirts are available for $10.

Full Name ________________________________________________________ Address _____________________________City__________________ State_________Zip_________ Email_______________________________________Phone____________________________ Gender (please circle) M / F Birth Date_______________ Age on Event Day_______

Additional Rider: _______________________________________________________________ Emergency Contact: Name ______________________________Phone _________________ Optional: 2014 T-shirts are available for an additional $10, if registered by May 3 rd , Please Circle Adult Shirt Size: S M L XL XXL 3XL

Motorcycle Registration Fee ($30) ______ Additional meal tickets ______ ($10 each) Additional Donation _________ Please Make Checks Payable to: Allies Angels

Additional Rider Fee ($10)______

Mail Pre-Registration and Payment to: 50 Youngs Road Port Crane, NY 13833

I cannot attend Allie's Angels Ride, but I would like to donate and be a Friend of Allies Angels _________

Waiver for Motorcycle Ride Participants: In consideration of being permitted to participate in any way in Allies Angel Ride, hereinafter called "The Ride", I, for myself, my heirs, personal representatives or assigns, do hereby release, waive, discharge, and covenant not to sue Allies Angels, its officers or agents from liability from any and all claims including the negligence of Allies Angels, its officers and agents, resulting in personal injury, accidents or illnesses (including death), and property loss arising from, but not limited to, participation in The Ride. Assumption of Risks: Participation in The Ride carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. The specific risks vary from one activity to another, but the risks range from 1) minor injuries such as scratches, bruises, and sprains 2) major injuries such as eye injury or loss of sight, joint or back injuries, fractures of bones and/or limbs, heart attacks, and concussions to 3) catastrophic injuries including paralysis and death. Indemnification and Hold Harmless: I freely agree to INDEMNIFY AND HOLD Allies Angels HARMLESS from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorneys fees brought as a result of my involvement in The Ride and to reimburse them for any such expenses incurred. Severability: The undersigned further expressly agrees that the foregoing waiver and assumption of risks agreement is intended to be as broad and inclusive as is permitted by the law of the State of New York and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. Permissions: Allies Angels has my permission to use my photograph, video and audio recordings, likeness, artwork, profile and/or story in this and future publications, web pages and other promotional materials produced, used by and representing Allies Angels. I understand the circulation of the materials could be worldwide and that there will be no compensation to me for this use. Acknowledgment of Understanding: I have read this waiver of liability, assumption of risk, and indemnity agreement, fully understand its terms, and understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am signing the agreement freely and voluntarily, and intend by my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law.
Signature _________________________________________________Date:______________ Printed Name ______________________________________ Please return this completed form along with the registration form and a check payable to: Allies Angels, 50 Youngs Road, Port Crane, NY 13833 Parent/Guardian Signature _________________________________Date_______________ Printed Name_____________________________________ ***** Minors under age 18 will only be allowed to participate in the motorcycle ride as passengers*****