Name:

First Last   Rider Nickname

Address:   Street       City State         Zip

Phone: Home Cell

 E-mail:

Spouses Name (if applicable):

Emergency Contact Information:

Name: Phone Number:

I am a member in -

American Legion  Sons of the American Legion Auxiliary

Membership Number:

Post Number:           

About Your Bike:

Make Model Year  Displacement

Check the box below that is the most applicable

I certify that the vehicle listed above is registered in my name in accordance to with state, city, and local licensing and registration requirements.   I further certify that I carry property and liability insurance for myself, my passengers, and my motorcycle which meets at least the minimum state, city, and/or local requirements. I also certify that I carry a valid drivers license with either a cycle endorsement or a valid Motorcycle Instruction Permit in accordance with state, city, and/or local laws.  If my status changes I will request, complete, and submit a new Membership Information Form.

I will be joining as the passenger of the following rider . I will not be operating a motorcycle as an American Legion Rider but will be participating in American Legion Rider events as a passenger. If my status changes I will request, complete, and submit a new Membership Information Form.

By submitting the form above I certify that the information above is true and accurate to the best of my knowledge.  I agree that the American Legion and the American Legion Riders Motorcycle Association shall not be liable or responsible for damage to property or any injury to persons including myself during any American Legion or American Legion Riders activities, even where the damage or injury is caused by negligence.  I understand that and agree that all American Legion Rider members and their guest participate voluntarily and at their own risk in all activities of the American Legion and the American Legion Riders.  I release and hold the American Legion Riders, the American Legion Riders Officers and the American Legion harmless for any injury or loss to my person or property, which may result there from.  I understand that this means that I agree not to sue the American Legion Riders, the American Legion Rider Officers or the American Legion for any injury or my property in connection with any American Legion or American Legion Rider activities.  I further agree that I am responsible to provide adequate insurance on my motorcycle or any other vehicle I use, operate or am responsible for while participating in an activity of the American Legion or American Legion Riders to cover liability in case of accident or injury.

Would you like to be contacted by the Chapter?

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