Membership Form

MANCUNIUM CHAPTER H.O.G. #8587

CHAPTER MEMBERSHIP – ENROLMENT FORM AND RELEASE Sponsoring Dealership - Manchester Harley‐Davidson®
Application for JUNIOR Membership

Completion of this form does not guarantee acceptance into the MANCUNIUM CHAPTER #8587

There are no Membership fees for Junior membership (open to ages 0 to 18 years old) however (a parent or family member or relative must be a full aid up member of the Mancunium Chapter, that 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. Junior Memberships will be renewed annually once full adult membership is renewed in June. (Only exception to HOG membership is for social members).
Junior Members Full Name

First NameUsed name or nick nameLast Name
Date of Birth

DayMonthYear
Date
Address

Address

Address Line 2

CityCounty

Postal CodeCountry
2nd Junior Members Name (if required)

First NameUsed name or nick nameLast Name
Date of Birth

DayMonthYear
Date
3rd Junior Members Name (if required)

First NameUsed name or nick nameLast Name
Date of Birth

DayMonthYear
Date
4th Junior Members Name (if required)

First NameUsed name or nick nameLast Name
Date of Birth

DayMonthYear
Date
Parent / Family member / Relative / Responsible Adult: for Junior Member
You must be a member of the Mancunium Chapter. Before a Junior can join the Chapter. Your UK H.O.G. membership must be up to date.
Sponsoring Members Name

First NameUsed name or nick nameLast Name
Your Relationship to Junior Member
Address

Address

Address Line 2

CityCounty

Postal CodeCountry
Contact Phone Number (mobile)
Format: 00000 000000.
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

DayMonthYear
Your UK H.O.G. membership must be up to date, if you have a life membership please use date 31.12.2099
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. I hereby confirm that I have no objection that my junior members 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:
Signature
Emergency Contact Information: (second parent, relative or responsible adult).
Name of Emergency Contact

First NameLast Name
Phone Number
Please enter a valid phone number
Email
example@example.com
Relationship to Junior Member
Should be Empty:

MANCUNIUM CHAPTER H.O.G. #8587