Chrome Riders
Membership Enrollment Form

Name: Birth Date:
Street Address:
City: State: Zip Code:
Phone: Daytime Phone: Email:
Chrome Rider Number: Expiration Date:

* THIS IS A RELEASE, READ BEFORE SIGNING *

I agree that the Chrome Riders or affiliated corporations, owner, 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 during any scheduled or non-scheduled activities, even where the damage or injury is caused by negligence (except willful neglect). I understand and agree that all Chrome Rider members and their guests participate voluntarily and at their own risk in all Chrome Riders 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 Chrome Riders activities and Event(s). I UNDERSTAND THAT THIS MEANS THAT I AGREE NOT TO SUE THE "RELEASED PARTIES" FOR ANY INJURY OR DAMAGE TO MYSELF OR MY PROPERTY RESULTING FROM, OR IN CONNECTION WITH, ANY Chrome Riders ACTIVITIES OR EVENTS.

* WAIVER OF RIGHTS UNDER STATE STATUTES *
 

I further agree to waive all benefits flowing from any state statute which would negate or limit the scope of this Release and Indemnification Agreement including, but limited to, Section 1542 Civil Code which provides:

"A general release does not extend to the claims which the creditor does not know or suspect to exist in his favor at the time of executing the release, which if known to him must have materially affected his settlement with the debtor"

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 representation made by the "RELEASED PARTIES"
 

MEMBER SIGNATURE: ______________________________________ DATE:

WITNESS:_________________________________________________  DATE:
(By Perent, Legal Guardian of a minor)                                                                                                                         

Annual Dues: Calendar Year 2007 - 2008   $ 20.00  Expires: April 01, 2008

________________________________________

________________________________________
For Club Use Only:
Dues Received By: __________ Date: __________ Dues Paid By: ______ Cash ______ Check
Computer Records Updated _____________ Chrome Rider Card Issued By: ______________

Please Fill In Online Form ...

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Print The Application in a pdf Format

Print and mail with payment to:

 Chrome Riders 
128 Kinwood Place
Williamstown NJ 08094-9747



 
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