CONFEDERATE HERITAGE RIDE 2022

REGISTRATION FORM

ABATE #

Preregistration forms can be mailed to:

Confederate Heritage Ride

103 Kingsbridge Drive

Goose Creek, SC 29445-6602

MUST BE RECEIVED BY: SEPT 22, 2022

NAME:
DATE OF BIRTH:
PHONE:
ADDRESS:
CITY/TOWN:
STATE:
ZIP:
E-MAIL:


PASSENGER NAME:
DATE OF BIRTH:
PHONE:
ADDRESS:
CITY/TOWN:
STATE:
ZIP:
E-MAIL:
ENTRY FEE FOR RIDER(DRIVER)-$25.00
$

(Drivers that pre-register receive a commemorative shirt*)

PASSENGER ENTRY FEE - $20.00 ea
$
Processing Fee 4.0%
$
(Passengers that pre-register receive a commemorative shirt)
Total:
$

SHIRT SIZE

(Preregistration Only)

Driver:
Passenger:

PREREGISTER—SEPT. 10 10AM till 4PM

&

PREREGISTER—SEPT. 17 10AM till 4PM

AT

Low Country Harley Davidson

4707 Dorchester Rd., N. Chas. , SC

or to register on Sept. 24th

The day of the ride, participants will need to be at Low Country Harley Davidson from 10 AM to 12 PM to receive their ride packet or to register. Each packet will contain the quiz w/directions, ride pin, meal ticket and participation ID band. The waiver MUST be signed prior to participating in the event and every participant (driver and passenger) must sign the waiver prior to participation.

SECESSION CAMP 4

CONFEDERATE HERITAGE RIDE

A PARTICIPATION FORM STATEMENT OF RESPONSIBILITY, RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT

You are VOLUNTARILY requesting participation in the CONFEDERATE HERITAGE RIDE herein referred to as CONFEDERATE HERITAGE RIDE, per Secession Camp 4. CONFEDERATE HERITAGE RIDE is a Secession Camp 4 chartered event for promoting heritage using the sport of recreational motorcycle driving. All events surrounding are sanctioned by the SECESSION CAMP 4. This sanction does not indicate that events, or any integral part of the events (i.e., locations, roads, etc.) have been inspected or approved by SECESSION CAMP 4 or CONFEDERATE HERITAGE RIDE, nor does it indicate that the officials have been trained or accredited by the SECESSION CAMP 4 or CONFEDERATE HERITAGE RIDE, nor does it indicate that your safety has been warranted by any SECESSION CAMP 4 or CONFEDERATE HERITAGE RIDE authority.

MOTORSPORTS ARE INHERENTLY DANGEROUS!!!

RIDE AT YOUR OWN RISK!! You should take part in SECESSION CAMP 4 / CONFEDERATE HERITAGE RIDE events based solely on your own assessment of your abilities. Events may traverse public property, private lands, and public roads, and SECESSION CAMP 4 / CONFEDERATE HERITAGE RIDE is not responsible for their condition or of your motorcycle and protective apparel. If you have entered a CONFEDERATE HERITAGE RIDE event and you have determined it to be unsafe or beyond your abilities, it is your responsibility to cease competition

SECESSION CAMP 4 DOES NOT PROVIDE MEDICAL INSURANCE

SECESSION CAMP 4 urges you not to compete in the CONFEDERATE HERITAGE RIDE without adequate medical insurance coverage. It is your responsibility to determine if you have adequate insurance.

READ CAREFULLY THIS IS A RELEASE

I HEREBY RELEASE, WAIVE, CONVENANT NOT TO SUE AND DISCHARGE the promoter, participants, participating heritage organizations, sanctioning organization or any subdivision thereof, road/track operator, road/track owner, officials, vehicle owners, riders, any persons in any restricted area, promoters, sponsors, advertisers, LAND OWNERS, lessees of premises used to conduct the event and each of them, their officers and employees, all for the purposes therein referred to as "Releasees", from all liability to the undersigned, my personal representatives, as-signs, heirs and next of kin for any and all loss or damage and any claim or any demand on account of any injury to the participant included, but not limited to, death whether caused by the negligence of the "Releasees", or otherwise while I am in or upon the restricted area and/ or competing, practicing, officiating in, observing, working and/or setting up for an event, or for ANY purpose participating in the event. This will also include camping out or use of rented land, by CONFEDERATE HERITAGE RIDE, for the purpose of practice or social events.

I HAVE READ AND UNDERSTAND THIS FORM. MY SIGNATURE BELOW INDICATES THAT I AGREE TO THE CONTENTS OF THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT.

Signature

Clear

Date

Passenger

Clear

Date

MINORS NEED PARENT OR GUARDIAN SIGNATURE (ANY PARTICIPANT UNDER 18 YEARS OF AGE)

Parent or Guardian

Clear

Date