2016 Howard E. Vander Clute, Jr. Memorial Motorcycle Ride Final Stop: Charlotte, NC, July 23, 2016
PERSONAL INFORMATION Rider’s Full Name ____________________________________________________________ Street Address _______________________________________________________________ City/State/Zip ________________________________________________________________ E‐mail ____________________________________________________Phone _____________ Passenger’s Full Name ________________________________________________________ VFW Post/Auxiliary # __________________
REGISTRATION FEE (Free to active duty military)
$15.00 Per Rider $10.00 Per Passenger TOTAL
________ ________ ________
PAYMENT: Circle one ‐ Mastercard Visa Discover Amex Check Enclosed
Card Number ______________________________________ Expiration Date ____________ Name on Card _______________________________________________________________
RIDER/PASSENGER RELEASE ‐ As a condition of my voluntary participation in the Howard E. Vander Clute, Jr. Memorial Motorcycle Ride, and on behalf of myself and my heirs and assigns, I hereby release and discharge the Veterans of Foreign Wars of the United States, their officers, employees and agents and its affiliated organizations and their respective officers, employees and agents from any and all claims, demands, damages or liabilities arising from injuries to my person or property as the result of participating in the Ride.
I currently hold a valid driver’s license with an endorsement to operate a motorcycle, and I have comprehensive motor vehicle liability insurance covering the vehicle, which I will be operating in the Ride.
I will abide by all laws relating to the ownership and operation of motorcycles in all applicable jurisdictions while participating in the Ride.
Rider Signature _________________________________________ Date ______________ Passenger Signature _____________________________________ Date ______________
Please complete and mail this form to Programs Department, VFW National Headquarters, 406 West 34th St., Kansas City, MO 64111. All net proceeds from the Ride will be donated to the VFW’s Veterans & Military Support Programs for support of the military and their families.
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