REGISTRATION 2010

RIDER/DRIVER NAME______________________________________PHONE____________ $25.00

PASSENGER NAME________________________________________PHONE____________ $10.00

DRIVER ADDRESS_________________________________________STATE_____ZIP__________

TYPE OF BIKE/CAR___________________PLATE #_____________YEAR______ PAYMENT ______

How did you hear about our event? _______________ Email Address ______________

I certify that I hold a current and valid driver’s license, registration and personal injury and property liability insurance for the motorcycle/car I am riding/driving in this event. DATE______________SIGNATURE________________________________________

Date of Event: Sunday August 15, 2010 (rain date, August 22, 2010) Registration Time: 10:00-11:00 Location: Begin at Bath Fitter (Bernardston Rd.) in Greenfield and end at Camp Lion Knoll in Leyden, Mass.

WAIVER OF LIABILITY AND INDEMNIFICATION AGREEMENT:

In consideration for receiving permission to participate in the Benefit Ride for the Girls Club of Greenfield (hereinafter the activity), I, for myself, my heirs, personal representatives and assigns, do hereby RELEASE, WAIVE, AND DISCHARGE, the Girls Club of Greenfield, including their employees, officers, directors, shareholders, successors, members, and assigns (hereinafter the releasees) from any and all liability, claims, demands, actions and causes of action whatsoever arising out of or relating to any loss, damage, or injury, including death, that may be sustained by me, or any of the property belonging to me, whether caused by the negligence of the releasees or otherwise, while participating in the activities or while in, on, or upon the premises used for the activities, whether owned, leased, or used by permission. This release extends to any and all claims I have or later may have against the releasees resulting from or arising out of their performance of their duties, whether or not such claims result from negligence on the part of any or all of the releasees with respect to this event or with respect to the conditions, qualifications, instructions, rules or procedures under which the event is conducted, or from any other cause. I am experienced in and familiar with the operation of motorcycles and fully understand the risks and dangers inherent in motorcycling. I am voluntarily participating in the event and I expressly agree to assume the entire risk of any accidents or personal injury which I might sustain to my person and property as a result of my participation in the event. I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating in the activity, or else I agree to bear the costs of such injury or damage myself. I further certify that I have no medical or physical conditions that could interfere with my safety in this activity, or else I am willing to assume, and bear the cost of,  all risks that may be created, directly or indirectly, by any such condition. I agree and promise to follow all applicable rules, laws, and regulations. I agree not to sue the releasees on account of any claim arising out of my participation in the activities. I further agree to indemnify and hold harmless the releasees from any loss, liability, damage or costs, including court costs and attorney fees, that they may incur due to my participation in the activity whether caused by the negligence of the releasees or otherwise. It is my express intent that this Waiver of Liability and Indemnification Agreement shall bind the members of my family and spouse, if I am alive, and my heirs, assigns and personal representatives, if I am deceased, and shall be deemed as a RELEASE, WAIVER, DISCHARGE AND COVENANT NOT TO SUE the above-named RELEASEES. I hereby further agree that this Waiver of Liability and Indemnification Agreement shall be construed in accordance with the laws of the Commonwealth of Massachusetts. IN SIGNING THIS RELEASE, I ACKNOWLEDGE AND REPRESENT THAT I have read the foregoing Waiver of Liability and Indemnification Agreement, fully understand its terms, understand that I am giving up substantial rights, including my right to sue, and sign it voluntarily as my own free act and deed; no oral representations, statements, or inducements, apart from the foregoing written agreement, have been made; I am at least eighteen (18) years of age and fully competent; and I execute this Release for full, adequate and complete consideration fully INTENDING MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY to the greatest extent allowed by law.

RIDER/DRIVER  ______________________________________________

                    Signature                                               Date