Membership Form

A VALID H.O.G.® MEMBERSHIP IS REQUIRED FOR ALL MEMBERS of the MANCUNIUM CHAPTER

Completion of this form does not guarantee acceptance into the MANCUNIUM CHAPTER #8702

Membership fees for 2024/25 are £25 for a Single Full Membership, £12.50 for a Family Membership (second member of your family who should also be member of HOG). The membership year runs from the 1st of June until the 31st of May. New Membership can be applied for at any time,

Type of Membership*

Single Membership -£25 per annJoint Membership - is £25 + £12.50 for a Family Membership (second member of your family who should also be member of HOG, if over 18).

Payment Type (please say how you are paying)*

Debit/Credit Card, (available, see bottom of form)Bank Transfer, (Sort code: 30-90-16 Account no: 02833526) using your initial and surname as the reference

Full Name*

First NameUsed name or nick nameLast Name

Address*

Address

Address Line 2

CityCounty

Postal CodeCountry

E-mail*

example@example.com

Contact Phone Number (mobile)*

09876 123456

Your HOG Membership Number (numbers only)*

You must be a UK H.O.G. member before you can join any UK H.O.G Chapter.

Expiry date of HOG membership*

Your UK H.O.G. membership must be up to date, if you have a life membership please use date 31.12.2099

Your Bike Reg *

Bike Model *

Sportster/Road Glide/etc

Vin Number *

From frame of Registration Doc

Current Mileage*

If you have more than one Harley-Davidson. Please send details of all your H-D bikes that you are riding. email - mileage@mancuniumchapter.co.uk with your (HOG Membership number, REG, VIN Number and Mileage for each bike).

Joint Membership for Family Member

Second Members Name

First NameUsed name or nick nameLast Name

Contact Phone Number (mobile)

Email

example@example.com

HOG Number (numbers only)

You must be a UK H.O.G. member before you can join any UK H.O.G Chapter.

HOG Expiry Date

Your UK H.O.G. membership must be up to date, if you have a life membership please use date 31.12.2099

Second members Signature

If the second family member is also a Harley-Davidson owner/rider please compleat the following:-

Your Bike Reg

Bike Model

Sportster/Road Glide/etc

Vin Number

From frame of Registration Doc

Current Mileage

THIS IS A RELEASE, READ BEFORE SIGNING:

I agree that the Sponsoring Dealer, Harley Owners Group (H.O.G.), H.O.G. Chapter Officers, Harley‐Davidson, Inc., Harley‐Davidson Motor Company, Harley‐Davidson Europe, Ltd, and any of its corporate affiliates, and their respective officers, directors, employees and agents (hereinafter, the "RELEASED PARTIES") shall not be liable or responsible for damage to my property occurring during any H.O.G. or H.O.G. Chapter activities and resulting from acts or omissions occurring during the performance of the duties of the Released Parties, even where the damage is caused by negligence (except wilful intent). I understand and agree that all H.O.G. members and their guests participate voluntarily and at their own risk in all H.O.G. activities and I assume all risks arising out of the conduct of such activities. I release and hold the "RELEASED PARTIES" harmless from any loss to my property which may result from my participation in H.O.G. activities and EVENT(S). I UNDERSTAND THAT THIS MEANS THAT I AGREE NOT TO SUE THE "RELEASED PARTIES" FOR ANY DAMAGE TO MY PROPERTY ARISING FROM, OR IN CONNECTION WITH, THE PERFORMANCE OF THEIR CHAPTER DUTIES IN SPONSORING, PLANNING OR CONDUCTING SAID EVENT(S), EXCEPT IN THE CASE OF WILFUL INTENT BY THE RELEASED PARTIES. Nothing in this disclaimer is intended to release any party mentioned herein for any liability for injury or death cause through that party’s negligence. I understand that the RELEASED PARTIES may take photographs of participants at the EVENT(S) for use in H.O.G.® related materials. I hereby confirm that I have no objection that my photograph is taken and used in this context and for this purpose. By signing this Release and Authorisation to Photograph, I certify that I have read this Release and fully understand it and that I am not relying on any statements or representations made by the RELEASED PARTIES.

DATA PRIVACY STATEMENT, READ BEFORE SIGNING:

The information you provide in this form will be used solely for dealing with you as a member of the MANCUNIUM CHAPTER (“The Chapter”). The Chapter has a Data Privacy Policy which can be found on the MANCUNIUM CHAPTER website, in the section “ H.O.G. Compliance Information" found at the bottom of any web page.

Your data will be stored and used in accordance with this Policy. By signing this form you are consenting to The Chapter to collect this data, store it and process it only for the purpose of running The Chapter and keeping a record of your participation as a guest. Photographs or videos may be taken at ride outs or events organised by The Chapter and those published on our website or social media channels to promote The Chapter. By participating in these ride outs or events you will be consenting to your image being used by The Chapter in this way.

If you later wish to withdraw consent, please contact the Director by email director@mancuniumchapter.co.uk

By you submitting images to The Chapter to be used on our website or social media, you agree to assign any right of ownership of those images to The Chapter.

Declarations:*

I have read the Annual Charter for H.O.G. Chapters and hereby agree to abide by it as a member of this dealer sponsored Chapter.I have read the By‐Laws for the MANCUNIUM CHAPTER and hereby agree to abide by them as a member of this dealer sponsored Chapter.I recognise that while this Chapter is chartered with H.O.G., it remains a separate, independent entity solely responsible for its own actions.I have read the information regarding Data Privacy, and hereby give my permission for the Mancunium Chapter to hold my details.

Signature*

How did you hear about the Mancunium Chapter?*

Please give names of any friends who are Chapter members:

	Full Name	Address	Contact Number
1
2

Are you or have you ever been in any other H.O.G. Chapter

Name of HOG Chapter

Are you or have you ever been in any other motorcycle clubs

List any clubs

Emergency Contact Information:

Name of Emergency Contact

First NameLast Name

Phone Number

Please enter a valid phone number

Email

example@example.com

Payment Information:

Total amount paid today*

What is the total amount you are sending

How have you sent your payment ?*

Bank Transfer, (Sort code: 30-90-16 Account no: 02833526) using your initial and surname as the reference

IF YOU ARE PAYING WITH BAC's PLEASE GO TO THE SUBMIT BUTTON AT THE BOTTOM.

Any question's or comments ?

Card payments ONLY - PLEASE ONLY COMPLETE THE FOLLOWING IF YOU ARE PAYING BY CARD:-

If you would like to pay with a Credit / Debit Card, please TICK the appropriate box below.

Don't forget to click the Submit button below to send your form to the Membership Officer and also confirm how you have paid your membership fee's

Please make sure you get the "thank you" confirmation to confirm you have filled in the form correctly.

NOTE: we use a secure on-line payment system we can not see your card details.

Please select one of the memberships below if you are paying by Credit/Debit Card

New Member Joining part way through year. Product Image

New Member Joining part way through year.Single Membership for new member joining part way through the year the membership year runs from the 1st of June until the 31st of May. Cost of membership £25 per ann. this is reduced to £10 for the 3 months Feb, March, April. PLEASE SELECT from the pulldown box:- (1) for joining from June to January, select (2) if you are Joining in Feb, March or April. If you are joining in May please select (3) for 13 months of membership

£ Free For joining from June to January, select (1)
Item subtotal:£0.00

New Joint Family Members, joining part way through the year Product Image

New Joint Family Members, joining part way through the yearJoint Family Membership for new members joining part way through the year. The membership year runs from the 1st of June until the 31st of May. Cost of membership £37.50 per ann. this is reduced to £15 for the 3 months Feb, March, April. PLEASE SELECT from the pulldown box:- (1) for joining from June to January, select (2) if you are Joining in Feb, March or April. If you are joining in May please select (3) for 13 months of membership

£ Free For joining from June to January, select (1)
Item subtotal:£0.00

Total

£0.00

Credit Card

MANCUNIUM CHAPTER H.O.G. #8702

Credit Card