HEART OF AMERICA MOTORCYCLE ENTHUSIASTS
Membership Application Application Type:   New _____   Renewal _____

Name: _________________________________   Nickname: ________________

Address: _________________________________________________________

City: _______________________  State: ____   Zip: _________

Home Phone: ___________________ Work Phone: ____________________

E-mail: ___________________________

Suggestions for club operation, activities, etc: _____________________________

_________________________________________________________________

WAIVER OF LIABILITY, INDEMNITY AND MEMBERSHIP AGREEMENT

As a new or renewal member of the Heart of America Motorcycle Enthusiasts Motorcycle Club
(HoAME), I agree to be aware of and responsible for my conduct as a HoAME member and
as a motorcyclist before the public.

In consideration of and as partial payment for my acceptance as a HoAME member, I do for
myself, my heirs, executors, legal representatives, administrators and assigns, hereby give up,
release, and forever discharge in advance my rights to sue or make any claim for damages
due to negligence or carelessness against HoAME and its Officers, Directors, and ride
leaders for injury to a person or property that I may suffer, including crippling injury or death,
while participating in HoAME activities, rides and events, whether they are formal or informal.

I am aware that motorcycling carries a significant risk of serious personal injury, death and
property damage. I know the risks of danger to myself, my minor child (if present) and my
property while participating in HoAME activities, rides and events and, relying upon my own
judgement and ability, I assume all such risks of loss and hereby agree to reimburse all costs
to, and forever hold harmless and indemnify, HoAME and all persons identified above,
generally and specifically, from any and all liability for death and/or personal injury and property
damage resulting in any way from my participation in HoAME activities, rides or events,
whether they are formal or informal.

Applicant Signature: ________________________________   Date: __________________