~ Membership Application ~
Events have led us to seek legal advice to help limit liability of any member, officer, or the Executive Board in the event that an incident may occur. We now require you to complete a waiver/hold harmless agreement and remit a copy of your current valid motorcycle license and insurance card. (All information will remain strictly confidential, but if you are not comfortable you can BLACK OUT your License #, DOB, Insurance Policy #, and VIN).
~ Waiver & Hold Harmless Agreement ~
 

By signing this membership form I, the undersigned, on behalf of myself, my heirs, successors or any personal representatives in exchange for joining and participating in Salt City Riders “Activities” or “Rides” (hereinafter, Events) agree to release and hold harmless all officers, directors and fellow members (hereinafter, Released Parties) any claims or demands, rights and causes of action of any kind whatsoever in the present or later against any above Released Parties, arising out of, or in connection with any activities associated with any Salt City Rider club, member or officer Events. The undersigned also agrees to each of the following categories to join and participate in club Events and will openly abide by the rules being of legal age of at least 21 years of age.

1. The undersigned agrees that he or she will follow all local, state and federal laws, statutes, ordinances or regulation and shall be held personally liable for all fines and penalties for traffic law violations.

2. The undersigned also agrees to wear at least the minimum safety apparel as required by state law which will include a helmet (recommended DOT approved) along with face shield, glasses or goggles. Strongly recommended to wear additional outer protective gear such as gloves, boots, long sleeved pants and shirt while participating in any event. Rider understands that failure to wear proper safety apparel can lead to serious injury and even death.

3. THE UNDERSIGNED ASSUMES FULL RESPONSIBILITY FOR ANY RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE, and any negligence on the part of any or all of the Released Parties in performing their respective duties.

The undersigned acknowledges and agrees that riding can be a dangerous activity and involves the risk of serious injury. The undersigned has read and voluntarily signs the release and waiver of liability and indemnity agreement.

Signature Driver_______________________________   Print Name__________________________
Signature Driver_______________________________   Print Name__________________________
Signature Passenger___________________________   Print Name__________________________
Date__________________

 

ADDITIONAL INFORMATION:                                 Do you need a membership card? (Yes / No)
Address, City, State, Zip: ____________________________________________________________
Phone: (optional) ___________________________________________________________________ Motorcycle(s) => Year, Make, Model: __________________________________________________
Email Address for Newsletter: ________________________________________________________

Please make check out to: Marty Hores
Mail to: Jackie Hores
8791 Honeycomb Path
Brewerton, NY 13039

        Please remember to include:  
            
 • Copies of License and Insurance Card.
              • $30.00 donation per couple.
              • $15.00 donation per single.