Rollin’ with the Angels

Motorcycle Ride

June 12, 2010

REGISTRATION FORM

Registration fee:  $25.00 per player

(non refundable)

Please Print Legibly:

NAME _______________________________________________________________________

ADDRESS________________________________CITY_____________STATE______ZIP______

PHONE (    ) __________________________E-MAIL__________________________________

NAME OF PASSENGER _________________________________________________________

Check here if you will be participating in the Dice Run

Check here if passenger will also be participating in the Dice Run

Proceeds from Rollin’ with the Angels benefit Angels’ Attic

RELEASE AND WAIVER OF RISK

I understand that my participation in the Angels’ Attic motorcycle ride can expose me to both known and unanticipated risk.  In consideration for being allowed to participate in the event.  I hereby assume all risk of injury and/or loss of property and waive any rights I might have to compensate.  I do hereby release the Angels’ Attic Ride, their sponsors, their employees, agents and/or representatives, and anyone else associated with the Angels’ Attic Ride, including their volunteers, from any and all claims or liability for personal injury and property damage I may suffer in regard to my participation in the Angels’ Attic Ride, even if caused by the negligence of any and all of the released parties.  I agree to indemnify and hold harmless and release parties from any cost or damage, including attorney fees, incurred as a result of my violation of the Release and Waiver of Rights.

I have read the above assumption of risk and release and waiver of liability,

I understand what I have read, and sign it voluntarily.

___________________________________________________________  ______________________________________

Driver signature (REQUIRED)               Date

___________________________________________________________  ______________________________________

Passenger Signature (REQUIRED)                Date

___________________________________________________________   ______________________________________

Minor passenger SIGNATURE OF LEGAL GUARDIAN                         Date

(under age 18)

Please fill out the form and mail to Angels' Attic, P.O. Box 375, Arcadia, IN  46030.  This form will help us determine how many riders to expect.  Please do no mail registration fee with your form.  Bring fee on the day of the ride due to the fact we have no rain date.

Ride date for 2010 will be June 12