POW/MIA AWARENESS RALLY Saturday, 11 July 2009 Start at 8am First Bikes out at 9am Rolling Thunder Event Entry Form & Waiver Fields in RED are required Rider Name Rider Address City State Zip Rider Phone Cell Rider Email Passenger Name Passenger Email Payment Information Rider Entry Fee $25 (will be $30 day of event) $25 Passenger Entry Fee $15 (will be $20 day of event) $15 TOTAL PAYMENT I plan to pay with PayPal to rollingthundertx1@yahoo.com    My PayPal id is: (PayPal id is for reference purposes ONLY) I plan to pay with cash when I arrive at the Rally I'm paying by check Payment by PayPal is strongly preferred *** There is a PayPal payment button on the next screen *** Make all checks payable to Rolling Thunder Tx 1. There is a FEE for ALL returned checks! Please mail waivers and any checks to: Nick Spencer, 12335 Kingsride #195, Houston, Tx. 77024 Note to the Registrar Waiver Information Please read the Waiver detailed here, and check the box at the bottom to signify that you agree with its terms. You will need to print out, sign, and mail in a copy of this waiver (available on the next page) ~or~ bring a signed copy to the Rally ~or~ be prepared to sign a copy at the Rally before you will be allowed to participate. Release and Waiver of Liability and Indemnity Agreement In Consideration for being permitted to participate in the annual Rolling Thunder event honoring Veterans and remembering our POW/MIA. . . THE UNDERSIGNED 1: Hereby Releases, Waives, Discharges And Covenants Not To Sue Rolling Thunder Texas, Chapter One, or it's National Office, any related companies or organizations, Officers, Directors, Management, Officials, Volunteers assisting in the event, American Honda Motor Company, or any of it's affiliates, or employees, sponsors, advertisers, vendors, and "Releases" from all liability to the undersigned, his / her personal representatives, assigns, heirs, and next of kin for any and all loss or damage, and any claim or demand therefore on account of injury to the person(s), or property, or resulting in death to the undersigned, whether caused by the negligence of the releasees or otherwise while the undersigned is participating in the event. 2: HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the releasees, and each of them from any loss, liability, damage, or cost (including attorneys fees) they may incur due to the presence of the undersigned participating in the event and whether caused by the negligence of the releasees or otherwise. 3: HEREBY AGREES that in order to participate in this event, undersigned rider / driver must provide / present a valid operators license upon check-in and receipt of armband. 4: HEREBY AGREES that while participating in the event, he or she will not ride while under the influence of alcohol, or any substance that affects the ability to operate or control his / her vehicle. 5: HEREBY AGREES that he or she will not use or operate any vehicle in violation or contravention of any city, county, state, or federal laws, statutes, ordinances, or regulation, and shall be personally liable for all fines and penalties for traffic law violations. 6: HEREBY AGREES to wear minimum safety apparel as required by state law. Minimum safety apparel may include a DOT approved safety helmet. Rider is strongly advised to wear a helmet whether required to do so by law or not, and is strongly advised to wear glasses, goggles, or face shield, and additional protective outerwear, such as gloves, long sleeve jacket, boots and long pants while participating in the event. Rider understands and acknowledges that failure to wear proper safety apparel may result in riders or passengers injury and or death. 7: HEREBY ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH, OR PROPERTY DAMAGE due to the negligence of releasees or otherwise while participating in the event. Each of the undersigned expressly acknowledges that the activities of the event are dangerous, and involve the risk of serious injury and/or property damage. The undersigned further expressly agrees that the foregoing release, waiver, and indemnity agreement is intended to be as broad and inclusive as permitted by the law of the state in which it is operated and that if any portion thereof is held invalid, it is agreed that the balance shall, not withstanding, continue in full legal force and effect. THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, and further agrees that no oral representations, statements or inducements apart from the foregoing written agreement have been made. The Undersigned also agrees to release the use of any photos, slides, videotapes, etc. that might contain the undersigned for future use in promotional and / or informational activities as deemed appropriate by any of the releases. Minors under the age of 18: Must have a parent or legal guardian present to sign a written waiver for each minor to participate and / or ride in a Rolling thunder event. If parent or legal guardian is not present, a notarized waiver must be supplied at registration. For Example: "The person named on this notarized form, name, has my permission to sign the minor release and waiver of liability for my minor child, name, to participate in and / or ride in the Rolling Thunder event in Houston, Texas on July 11nth, 2009." This form must be signed and notarized by a parent or guardian.   Checking this box indications understanding of and agreement to the above conditions          This page maintained by: Elektra Comments welcomed. 5/20/2009