Nation of Patriots Event Registration

Nation of Patriots Event Registration

To register and/or ride, input your information then pay the $20 per person fee at an event. If you are planning on riding in more than one event, the fee is $15 per person. Contact Lisa at (303) 910-6388 for help.
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone Number*
Please enter a valid phone number.
Will you be...*

riding a motorcycledriving a carjust attending event
Please select event(s) which you be attending:*

May 19th - Bike Night at Dillon Brothers Harley Davidson, OmahaMay 20th - Kickoff at SumpTur Amphitheater, PapillionSeptember 15th - Bike Night at Dillon Brothers Harley Davidson, OmahaSeptember 16th - Homecoming at SumpTur Amphitheater, Papillion

Complete the Patriot Tour Waiver Below

Please complete only if you will be riding with us and on a motorcycle.
ALL PARTICIPANTS MUST READ AND AGREE TO THE FOLLOWING:

The undersigned (on my behalf and of my heirs, personal representatives, successors, and assigns), for and in consideration of the opportunity to participate in the Patriot Tour{heinafter the Tour} managed and created by The Nation of Patriots and thier respective directors, officers, sponsors and volunteers {herein Released Parties}) releases and holds harmless the "Released Parties" from any and all claims and demands, rights and causes of action of any kind whatsoever which I now have or later may have againt the "Released Parties" in any way resultingfrom, ariving out of, or in connection with the performance of their duties and my participation in "The Patriot Tour". This release extends to any and all claims I have or later may have againt the "Released Parties" resulting from or arising out of their performance of thier organizational duties whether or not such claims result in negligence (except willful neglect) on the part of any or all of the "Released Parties" with respect to "The Patriot Tour" or with respect to the conditions, qualifications, instructions, rules, or procedures under which "The Patriot Tour" is conducted from any other cause. I UNDERSTAND THAT THIS MEANS THAT I AGREE NOT TO SUE ANY OR ALL OF THE "RELEASED PARTIES" FOR ANY INJURY RESULTING TO MYSELF OR MY PROPERTY ARISING FROM, OR IN CONNECTION WITH MY PARTICIPATION IN THE "PATRIOT TOUR" OR AGAINST THE "RELEASED PARTIES." I am experienced in and familiar with the operation of motorcycles and fully understand the risk and dangers inherent in motorcycling. I am voluntarily participating in "The Patriot Tour" and I expressly agree to assume the entire risk of my accidents or personal injury, including death, which I might sustain to my person or property as a result of my participation in "The Patriot Tour", and any negligence (except willful neglect) on the part of any and all of the "Released Parties" throughout "The Patriot Tour".

WAIVER OF RIGHTS UNDER STATE STATUES

I further agree to waive all benefits flowing from any state which would negate or limit the scope of this release and Indemnification Agreement, including, but not limited to Section 1542 of the California Civil Code which provides: "A general release does not know of suspect to exist in his or her favor at the time of executing this release, which if known to him or her must have materially affected his or her settlement with the debtor." By signing this "Release", I certify that I have read this "Release" and fully understand it and that I am not relying on any statements of representations made by the "Released Parties."
Participant's Name

First NameLast Name
Participant's Date of Birth

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Date
Today's Date

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Date
Emergency Contact's Name

First NameLast Name
Emergency Contact's Phone Number
Please enter a valid phone number.
Electronic Signature Consent*

By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. You agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.
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Nation of Patriots Event Registration

Complete the Patriot Tour Waiver Below