The State Police Soldiers of the Law
Memorial Ride

Saturday, April 25, 2009, 11:30 AM Departure (staging begins at 9:00 AM) Rain date: Sunday, April 26, with same Departure & Staging times Location: Ride Begins and ends at PSP Academy at Hershey PA

PROCEEDS FROM THE RACE WILL BENEFIT THE STATE POLICE
HISTORICAL, EDUCATIONAL AND MEMORIAL CENTER

REGISTRATION FORM
(Complete Form, Print and Mail)

    Participant Information

Name (last, first, middle initial)  
Mailing Address – Street
Mailing Address – City, State, Zip Code   -
Home Telephone with Area Code      -             Other Phone -
E-mail Address:
PSP Affiliation (Check One) Active Member Active Employee Retired Member Retired Employee Friend
T-shirt Size(s):
Order # Extras Here
(Check One)
Small   Medium Large XL XXL  Other Size:

Release
  (by completing the information,  you are acknowledging that you have read the below release)
Signature:__________________________________________________________ Date:
   Passenger Information (if applicable)
 
Name (last, first, middle initial)  
Mailing Address – Street
Mailing Address – City, State, Zip Code   -
Home Telephone with Area Code      -             Other Phone -
E-mail Address:
 
PSP Affiliation (Check One)  Active Member Active Employee Retired Member Retired Employee Friend
T-shirt Size(s):
Order # Extras Here
(Check One)
Small   Medium Large XL XXL  Other Size:

 

Release   (by completing the information,  you are acknowledging that you have read the below release )
Signature:__________________________________________________________ Date:
    
 



 
Emergency Contact Information
Name:

Telephone Number: -
       Cost                                                                                             

$25.00 per person
(includes 1 shirt for each)…
& buy extra shirts @ $15 each

Number of People 
  

Total # Extra Shirts

Total Enclosed
$


Remember to Sign your Registration Form Before Mailing


(or click control "P" for printing)

APPLICANTS MUST USE THIS TWO-SIDED FORM

HELMETS ARE REQUIRED!

In case of inclement weather,
the ride will be held on
Sunday, April 26th, 9 AM

with same Departure & Staging times Location

Uncertain about change to the Rain Date? e-mail “Jessica”:

psphemc@gmail.com

Your canceled check will be
your registration acknowledgement

 

Make Checks Payable to: PSP-HEMC Applications must be received by 4/2/2009
Mail completed registration form & payment to: The Pennsylvania State Police Soldiers of the Law Memorial Ride 187 East Hershey Park Drive, Hershey, PA 17033 (phone PSP-HEMC 717.534.0565)























 

RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AND PARENTAL CONSENT AGREEMENT (“AGREEMENT”)

IN CONSIDERATION of being permitted to participate in any way in “The State Police Soldiers of the Law Memorial Ride” sponsored Motorcycling Activities (“Activity”) I, for myself, my personal representatives, assigns, heirs, and next of kin:

1. ACKNOWLEDGE, agree, and represent that I understand the nature of Motorcycling Activities and that I am qualified, in good health, and in proper physical condition to participate in such Activity. I further acknowledge that the Activity will be conducted over public roads and facilities open to the public during the Activity and upon which the hazards of traveling are to be expected. I further agree and warrant that if, at any time, I believe conditions to be unsafe, I will immediately discontinue further participation in the Activity.

2. FULLY UNDERSTAND that: (a) MOTORCYCLING ACTIVITIES INVOLVE RISKS AND DANGERS OF SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS AND DEATH (“RISKS”); (b) these Risks and dangers may be caused by my own actions, or inactions, the actions or inactions of others participating in the Activity, the condition in which the Activity takes place, or THE NEGLIGENCE OF THE “RELEASEES” NAMED BELOW; (c) there may be OTHER RISKS AND SOCIAL AND ECONOMIC LOSSES either not known to me or not readily foreseeable at this time; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES I incur as a result of my participation or that of the minor in the Activity.

3. HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE The Pennsylvania State Police and/or The Pennsylvania State Police Historical, Educational & Memorial Center, their administrators, directors, agents, officers, members, volunteers, and employees, other participants, any sponsors, advertisers, and, if applicable, owners and lessors of premises on which the Activity takes place, (each considered one of the “RELEASEES” herein) FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON MY ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE “RELEASEES” OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS; AND I FURTHER AGREE that if, despite this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT I, or anyone on my behalf, makes a claim against any of the Releasees, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES from any litigation expenses, attorney fees, loss, liability, damage, or cost which any may incur as the result of such claim.

4. I GIVE THE PENNSYLVANIA STATE POLICE HISTORICAL, EDUCATIONAL & MEMORIAL CENTER UNRESTRICTED PERMISSION to use and/or publish pictures of me for promotional purposes. I hereby waive any right that I may have to inspect and approve the finished product or copy that may be used in connection with an image that the photographer has taken of me or the use to which it may be applied. I further release The Pennsylvania State Police Historical, Educational & Memorial Center from any claims for remuneration associated with any form of damage, foreseen or unforeseen, associated with the proper commercial or artistic use of images.  I also hereby give my permission to the media to use my name and/or picture in any media coverage without obligation to compensate me.

5. I consent to emergency medial treatment, including transport by ambulance to a hospital, if I am injured.

6. I agree to wear an ANSI, CPSA or Snell approved helmet on all motorcycle riding activities at this event.

I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT.

 

MINOR RELEASE

AND I, THE MINOR’S PARENT AND/OR LEGAL GUARDIAN, UNDERSTAND THE NATURE OF MOTORCYCLING ACTIVITIES AND THE MINOR’S EXPERIENCE AND CAPABILITIES AND BELIEVE THE MINOR TO BE QUALIFIED, IN GOOD HEALTH, AND IN PROPER PHYSICAL CONDITION TO PARTICIPATE IN SUCH ACTIVITY. I HEREBY RELEASE, DISCHARGE, COVENANT NOT TO SUE, AND AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS EACH OF THE RELEASEE’S FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON THE MINOR’S ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE “RELEASEES” OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS AND FURTHER AGREE THAT IF, DESPITE THIS RELEASE, I, THE MINOR, OR ANYONE ON THE MINOR’S BEHALF MAKES A CLAIM AGAINST ANY OF THE RELEASEES NAMED ABOVE, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES FROM ANY LITIGATION EXPENSES, ATTORNEY FEES, LOSS LIABILITY, DAMAGE, OR COST ANY MAY INCUR AS THE RESULT OF ANY SUCH CLAIM.

 

        KEY RIDE RULES:                (Note: Variety of Food & Beverages Available at ride start/end from PSP-HEMC)

·          Helmets Required

·          Ride staggered for maneuverability and safety (not side by side)

·          Two Second Rule for maximum following distance (avoids large gaps that can invite autos turning)

·          Move Up in your path of travel if rider ahead of you aborts the ride (no jockeying for position)

Special Note: Signatures Required on this Form!