If you pre-register by May 10, 2014 we will give you $5.00 off the below noted Ride fees.
INSTRUCTIONS: Complete and return this form to:
8444 w. McMyron St. West Allis, WI. 53214
Checks made payable to of the above named and C/O NAFFR-WI
Click above to Pre-Register and get qualify for Discounts
Registration will be from 9:00 AM to 11:30AM
Kick Stands up at 12 noon
Forms must be received no later than MAY 10, 2014!
$20.00 RIDER / $30.00 Couple
$15.00 Single / $25.00 Couple
Check and money orders only please.
Make out to the above noted person.
EVERYONE will be required to sign a waiver the day of the ride. Or please fill out the above waiver, copy and paste to a word document and mail along with this form.
You will not be allowed to participate otherwise. Your name will be in a ledger for faster sign-in there will be a separate line for all who have preregistered.
Phone Number(s): (Home)_____________________________(cell)________________________
Address: __________ City
Passenger Name :
Phone Number(s): (home)_____________________________(cell):______________________
Address: __________________________________ City:_________________ Zip:____________
Ride patches ($5.00 ea.) are available for purchase via our On-Line ordering ( See our Patches Side bar Modular).
They will be mailed to you after the ride.
For any further info or questions you may have please call the Wisconsin Ride Co-Coordinators noted below or send us an e-mail :
Tracy Sigrist at 414-350-2773
Carey Struebing at 262-224-5122
Total amount enclosed:______________
Copy this form and paste onto microsoft word and fill out and mail to the above noted address or send as an attatchment to :
PLEASE READ CAREFULLY BEFORE SIGNING
I expressly consent to participation in this special event .
The 5th National Armed Forces FreedomRide 2014 understand that
any and all recreational activities involve inherent and other risks of INJURY and DEATH.
In consideration for being permitted to participate in the EVENT, the event being The 5th National Armed Forces FreedomRide-WI 2014.
I voluntarily agree to expressly assume all risks of injury or death that may result from participation in the EVENT, or any other activity at the NAFFR-WI 2014 including all stops listed for event,Ride route provided and all sponsors or contributors for the EVENT, all employees, volunteer workers, agents, representatives, successors-in-interest, and assigns (collectively “Providers”) from all liability for injury, death, and property loss and damage that results from participation in EVENT, or is related to any other activity for the EVENT, including all liability which results from the NEGLIGENCE of PROVIDERS, or any other person or cause.
I further agree to defend and indemnify PROVIDERS for any loss or damage arising from claims or lawsuits for personal injury, death, and property loss and damage related to participation in the EVENT or any related activity of the EVENT.
I agree to drive safely at all times, to conduct myself in a responsible manner, to comply with all applicable safety and DOT laws, to carry insurance for my vehicle as required by The State law of Wisconsin as well as the rules and policies of the EVENT and any participating facilities.
I authorize any person connected with PROVIDERS or the EVENT to administer first aid to me, as they deem necessary. I authorize medical and surgical care and transportation to a medical facility or hospital for treatment necessary for my well-being, at my expense.
I agree that any and all photographs, videos, motion pictures, movies, or television coverage of me taken or made at any time during, by, or in connection with the EVENT, or any reproduction, likeness, or resemblance of the same, in any and every form, style, size, or color, as well as my name, may in any manner be used, published, displayed, dealt in, and copyrighted by PROVIDERS and/or their successors and assigns, or by any other person or business entity authorized by PROVIDERS, without any restriction or limitation whatsoever, for the marketing and promotion of future events and PROVIDERS.
This agreement is binding upon my heirs, executors, administrators, and assigns. I acknowledge this agreement is governed by the applicable laws of the State of Wisconsin.
If any provision of this agreement is held in whole or in part to be unenforceable for any reason, the remainder of that provision and of the entire agreement will be sever-able and remain in effect.
I HAVE READ, UNDERSTAND, AND VOLUNTARILY AGREE TO THIS AGREEMENT AND RELEASE OF LIABILITY.
Passenger's Sigature: ________________________________
Parent/guardian: If participant is a minor, I verify that I am the parent of guardian of the minor, and I have authority to enter into this agreement on behalf of the participant.
Copy this form and paste onto microsoft word and fill out and mail to:
8444 W. McMyron St
West Allis, WI. 53214
Or E-Mail it to: