Membership Renewal Form

 – THIS IS A RELEASE, READ BEFORE SIGNING –

In consideration for the opportunity of enrolling as a Chapter member:

(a) I understand and agree that all Chapter Members, H.O.G. members and their guests participate voluntarily in all (1) Chapter rides, and social events, (2) inter-chapter rides and social events (with other Chapters) and (3) H.O.G. Rallies (“EVENT(S)”) which may involve risks of loss and damage to property, injury and death. I am also aware that these risks include the danger of being injured by motorcycles, other motorized vehicles, other objects or the acts of others, and that by attending and participating in EVENT(S) I am taking on these risks;

(b) I agree that, if I am a consumer of the EVENT(S), I will not make any claim against the Sponsoring Dealer, H.O.G., Harley-Davidson Australia Pty Limited, Harley-Davidson, Inc., its affiliates and subsidiaries, Harley-Davidson Motor Company, my Chapter, other H.O.G. Chapters and their respective officers, directors, employees and agents (“RELEASED PARTIES”) for any mental or physical injury to me (including paralysis or death), disease or aggravation of an existing condition that is harmful or could cause harm, I suffer as a result of a RELEASED PARTY’s breach of its statutory obligation to provide services with due care and skill or which are fit for purpose, or to provide those services in a timely manner, unless that injury is caused by the RELEASED PARTY’s reckless conduct;

(c) I release and discharge the RELEASED PARTIES from, and will indemnify them for and against, any and all injury, loss or damage to my person or property, and any and all claims, demands, rights, losses (including loss of profits), damages, costs or expenses (including legal fees and costs of investigation), liabilities or causes of action of any kind whatsoever (“CLAIMS”), which may in any way arise out of or in connection with my participation in any EVENT(S) where (i) I have agreed not to make a CLAIM or (ii) to the extent that the CLAIM relates to my negligence, reckless conduct or intentional misconduct.

CONSUMER RIGHTS STATEMENT
As a participant in Chapter activities and other events, you may be a “consumer” of goods and services supplied by the Chapter or the Released Parties for the purposes of consumer protection legislation, including the Australian Competition and Consumer Act 2010 (Cth) and equivalent State legislation and the New Zealand Consumer Guarantees Act 1993 (referred to as “CONSUMER RIGHTS”).

Except as set out above, or as permitted by law, nothing in this Release is intended to exclude, restrict or modify your CONSUMER RIGHTS.

Membership Renewal Form

Your Contact Details

First Name: *

Surname: *

Address

Address

Street Address - Line 1

Street Address - Line 1

Street Address - Line 2

Street Address - Line 2

City

City

State/Province

State/Province

Zip/Postal

Zip/Postal

Country AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe

Country

Home Phone:

Mobile Phone:

Email Address: *

* This will be used to keep you updated on club rides and other events.

Confirm Email Address: *

Confirm Email

Your HOG International Details

International HOG Number: *

* Delete the "AU" prefix if you hold an Int. HOG membership with a different country outside of Australia

Are you an int. HOG Life member? *

Yes

No

Int. HOG Expiry Date: *

Payment Details

Total: *

AUD$

I will pay by: *

Cheque - (make payable to: Harley Owners Group - Cape York Chapter Inc)

Direct Bank Deposit / EFT - (Bank: Bendigo Bank | BSB: 633000 | A/C: 113462444)

* If paying by Direct Deposit or EFT, please use your Int. HOG number as the transaction reference.

Payment Date: *

You Agree

Acknowledgement: *

- By submitting this form I agree that I have read and understand the above terms and conditions. Furthermore, I also agree to allow Cape York Harley Owners Group to use my email address to alert me to club events and other news as appropriate. I acknowledge that I can opt out of any email communication by sending an email to info@capeyork-hog.com.au requesting same. I also provide consent for any images of myself taken during club activities to be posted on any of the digital channels utilised by Cape York Harley Owners Group in the promotion of club activities.

If you are human, leave this field blank.