10th Annual Tennessee State Rally
Registration Form

Proceeds Benefit St Jude Children's Research Hospital
 June 4th - June 6th, 2009

Rider:

________________________________________

Passenger:

________________________________________

Address:

________________________________________

City, ST, ZIP

________________________________________

Telephone #:

________________________________________

EMail Address:

________________________________________

Chapter Name:
________________________________________
Officer (Y.N): ______ Position: ______________________________________

Cost

Qty

Extended Amount

Full Registration: Includes 1 T-Shirt and 1 Pin

$15.00

ea

____

________

Extra Individual T-Shirts

$10.00

ea

____

________

Extra Individual Pins

$5.00

ea

____

________

Total:

__________

Pin and Shirt Quantities will be limited - register early!
T-Shirts (Specify Quantity)
S Qty M Qty L Qty XL Qty 2X Qty 3X Qty 4X Qty 5X Qty
________ ________ ________ ________ ________ ________ ________ ________

To Preregister, Print this Page, Complete (including Waiver Below) and mail along with check for total amount
made payable to:
"Bill McEachern"  with "TNRally09" in remarks to:

William McEachern
1345 Maria St.
Memphis, TN  38122
OR
Pay By Paypal by clicking on following link:

RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT IN CONSIDERATION

Date: 13 February 2010 RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT IN CONSIDERATION
for being permitted to participate in the 10th Annual Tennessee State Rally, for St. Jude Children's Research Hospital sponsored by the Southern Cruisers Riding Club at the Clarion Inn in Cookeville, TN the weekend of June 4-6, 2010.

THE UNDERSIGNED PARTICIPANTS:
1. HEREBY RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE The Southern Cruisers Riding Club, owners and lessees of premises used to conduct the event and each of them, their officers and employees, The State of Tennessee, the dealers, officers, directors, management, officials and volunteers assisting in the event, the sanctioning organization or any subdivision thereof, grounds operators, grounds owner, officials, promoters, sponsors, advertisers; all for the purpose herein referred to as releasees, from all liability to the undersigned, their personal representatives, assigns, heirs, and next of kin for any and all loss or damage, and any claim or demands therefore on account of injury to the person or property or resulting in death of the undersigned, whether caused by the negligence of the releasees or otherwise while the undersigned is participating in the event;
2. HEREBY AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS the releasees and each of them from any loss, liability, damage, or cost (including attorneys fees) they may incur due to the presence of the undersigned participating in the event and whether caused by the negligence of the releasees or otherwise.
3. THE UNDERSIGNED PARTICIPANTS agree that while participating in this event, the use of alcohol or any substance which affects the ability to operate or control his or her vehicle or may be considered as hazardous to the health and safety of participants and spectators is strictly forbidden.
4. THE UNDERSIGNED AGREES that he or she will not use or operate any vehicle in violation or contravention of any City, County, State or Federal laws, statures, ordinances or regulation and shall be personally liable for all fines and penalties for traffic law violations.
5. HEREBY ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE due to the negligence of releasees or otherwise while participating in the event. EACH OF THE UNDERSIGNED expressly acknowledges and agrees that the foregoing release, waiver, and indemnity agreement is intended to be as broad and inclusive as is permitted by law of the State in which it is operated in and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.
By my signature hereto, I acknowledge that I have read the above RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT and that I concur in its entirety, and further agree that no oral representations, statements or inducements apart from the foregoing written agreement have been made.

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Signature of Attendee