The Riders Application – American Legion

AMERICAN LEGION RIDERS' APPLICATION

Name *

First

Middle

Last

Nickname/Rider's Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Cell Phone

Secondary Phone

Email Address *

Alternate Email

Birth Date

Legion Family

Member
Legionnaire
Auxiliary
SAL

Post Name w/ #

Membership #

Your Bike's Make

Model

Year

Displacement/CC's

Checkboxes

I do not own a bike and will be joining as a passenger

Understanding the Legal Side: of the first two paragraphs below, check the box in front of the paragraph that is the appropriate statement that applies to you. On the last paragraph, type in your initials if you acknowledge and agree to the release of liability disclaimer. Upon pressing the submit button and submitting this applications you are agreeing to these statements as addresses below.

I the undersigned certify

I, the undersigned, certify that the motorcycle listed above is registered in my name and in accordance with state, city, and/or local licensing and registration requirements. I further certify that I carry property and liability insurance for myself, my passengers, and my motorcycle which meets at least the minimum state, city, and/or local insurance requirements. I also certify that I carry a valid driver's license with either a cycle endorsement or a valid Motorcyclist Temporary Instruction Permit in accordance with state, city, and/or local laws. If my status changes, I will request, complete, and submit a new Member Information Form.

I am joining as a passenger

I am joining as a passenger of the following Rider and will not be operating a motorcycle as an American Legion Rider, but may be participating in American Legion Rider events as a passenger. If my status changes, I will request, complete, and submit a new Member Information Form.

I upon pressing the submit button

I, upon pressing the submit button, agree that the American Legion, and the American Legion Motorcycle Association (henceforth referred to as 'The American Legion Riders' or simply as 'Riders'), shall not be liable or responsible for damage to property or injury to persons including myself during any Riders activities, even where the damage or injury is caused by negligence (except willful etc.). I understand and agree that all Riders members and their guests participate voluntarily, and at their own risk in all Riders activities. I release and hold the Riders officers and the American Legion harmless for any injury loss to my person or property that may result through my participation in the Riders and/or their activities. I understand that this means that I agree not to sue the Riders officers, whether local, state or national, nor the American Legion for any injury resulting to myself or my property in connection with and Riders activities.

Upon pressing the submit button below, I swear and certify, under penalty of perjury of the State of Arkansas, that the information provided herein is true and correct and I agree to follow the Constitution, Bylaws and rules of the American Legion, Siloam Post 29, and the American Legion Riders Chapter 29 of Siloam Springs, Arkansas 72761

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