4th ANNUAL
AN INTERNATIONAL GUIDING EYES PROGRAM
MEET AT Destination
Harley Davidson
2302
@
Awards
and Drawings
Coffee and Donuts at
sign in
1ST, 2ND,
3RD AND OLDEST & YOUNGEST LICENSED & ENDORSED MC RIDER
$20.00 DONATION PER PERSON
GRAND PRIZE DRAWING
REGISTRATION (PLEASE PRINT)
City, State/Province, Zip
Code________________________________________
CO-RIDER/PASSANGER_____________________________________
Date of Birth_______/_______/__________
Address_____________________________________________________
Telephone (_______)___________________
City, State/Province, Zip
Code________________________________________
I I understand that state law requires vehicles and drivers/riders to be appropriately licensed and endorsed and to have their own liability insurance to operate on state roads and highways and that it is my responsibility to provide that insurance. I therefore release and hold harmless the IAM & AW, Stuart Enterprises, Guide Dogs of America, event volunteers, sponsors/supporters, participating merchants and any event site owners and personnel from any responsibility for any damage or injury I may incur or cause while participating in this event.
I have read this form and
agree to the above statement (
______________________________________ _______________________________________
Rider/Driver
MUST BE PRESENT FOR ALL DRAWINGS AND AWARDS