Noble Few LEMC Membership Application
Membership application for the Noble Few LEMC
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APPLICATION TYPE
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NAME (First, Middle, Last)
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ADDRESS
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HOME PHONE
CELL PHONE
EMAIL ADDRESS
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OCCUPATION
WORK NUMBER
EMERGENCY CONTACT
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EMERGENCY NUMBER
DRIVERS LICENSE NUMBER AND CLASS *
INSURANCE COMPANY AND POLICY NUMBER
ARRESTED FOR A CRIME?
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BRIEF INFO:
CONCEALED CARRY PERMIT?
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ACTIVE/RETIRED (Check all that apply)
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Required
PREVIOUS MEMBER OF A MOTORCYCLE CLUB?
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IF YES, NAME
MEMBERSHIP SPONSORED BY (REAL AND ROAD NAME)
APPLICANT ROAD NAME
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ASSOCIATE NAME, IF APPPLICABLE
PRIMARY BIKE OWNED (MAKE, MODEL, YEAR)
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In consideration of being granted membership in the Noble Few Law Enforcement Motorcycle Club and in consideration of being permitted to participate in any and all club sponsored functions and activities (collectively, the “Events”), I agree to the following:1. Liability Release and Assumption of Risk: I understand that  my participation in an Event can expose  me to dangers both from known and unanticipated risk, including, but not limited to, risk associated with riding my motorcycle to, from or during an  Event or interaction with persons, including other members or others at an Event. I willingly and voluntarily assume all such risks, including those of loss, damage or injury, including death, to myself and/or my property from any cause whatsoever. Moreover, acknowledging that such risk exists, I, for myself, my heirs, personal representatives and assigns, hereby release, discharge and hold harmless the Noble Few Law Enforcement Motorcycle Club, and any of its affiliates, the promoters, the landowners, and the sponsors, if any, co -hosting an Event;  the  owners  and  representatives,  agents,  members,  successors,  assigns,  affiliates,  and  employees  of  all  of  them  (collectively “Released Parties”) from any and all claims or liability for personal injury, including death, or property damage I may suffer resulting  from, arising in connection  with, or related to the  Event,  including, but  not limited to, any claims arising out of the  conduct  of any Event or Event-related activity. I specifically release the Released Parties and each of them for the negligence, in any form of any or all the Released Parties. In signing this release, I FULLY RECOGNIZE THAT IF I AM HURT AND/OR MY PROPERTY  IS  DAMAGED  IN  CONNECTION  WITH  THE  EVENT,  I  WILL  HAVE  NO  RIGHT TO  MAKE  A  CLAIM  OR FILE A LAWSUIT AGAINST THE RELEASED PARTIES, EVEN IF THEY OR ANY OF THEM CAUSED MY DEATH, INJURY OR DAMAGE.2. Indemnification: I agree to indemnify and hold harmless the Released Parties, individually and/or collectively, from all lawsuits, claims, damages, costs, and attorneys’ fees that arise out of my presence or conduct at an Event and/or my violation or my representative’s violations of any provision of the Application. This provision will apply regardless of whether the lawsuit, claim, damages, costs and/or attorneys’ fees arise out of the negligence, in any form, of any of the Released Parties. As I am releasing any claim my family, guardian, representative and/or estate might wish to make by reason of my injury or death, this indemnity provision shall specifically apply to such actions on my behalf and/or any such actions resulting from my injury or death.  3. Insurance Responsibility:  I understand that the Noble Few Law Enforcement Motorcycle Club provides neither health and/or life insurance. I assume all responsibility for my doctor and/or hospital expenses and any loss or injury to personal property or myself in which I may become involved in by reason of participating in an Event.   I certify that I have completely read this Application and by signing below, accept the foregoing as a condition of my Membership. *
Required
SIGNATURE (TYPED NAME WILL BE CONSIDERED VALID SIGNATURE)
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DATE
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MM
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DD
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YYYY
CHAPTER PRESIDENT APPROVAL
DATE APPLICATION APPROVED
MM
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DD
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YYYY
DUES PAID
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