The
American Legion
Riders
of Canton, Illinois

Last Name:_________________________________First Name:_________________________________

Nickname/RiderName:___________________________________________________________________

Home Address:___________________________________ Apt:__________________________________

City: ___________________________________________State: _____________ Zip: _________________

Home Phone: (_____)__________-___________ Cell Phone: (_____)________-____________

Wife/Husband/S.O.Name:_________________________________________________________________

Birth Date: _______/_________/_________ email address:_______________________________________

Member of: o Legion o SAL o Auxiliary at Post# ______________AL/SAL/AUX Member#___________

Emergency Contact Name:______________________________________ Phone: (____)________-__________

About Your Bike: Complete this section if you will be riding a motorcycle with the ALR. Cross it out if you will be a passenger.

Make: ___________________________ Model: __________________________ Displacement:______________

About the Lawyers: Check the box alongside the appropriate statement below, draw a large "X" through the statement that does not apply to you, and sign and date BOTH sections. If you do not own a motorcycle, also put a large "X" through the "About your bike" section.

p "I, the undersigned, certify that the motorcycle listed above is registered in my name and in accordance with state, city, and/or local licensing and registration requirements. I further certify that I carry property and liability insurance for myself, my passengers, and my motorcycle which meets at least the minimum state, city, and/or local insurance requirements. I also certify that I carry a valid driver’s license with either a cycle endorsement or a valid Motorcyclist Temporary Instruction Permit in accordance with state, city, and/or local laws. If my status changes, I will request, complete, and submit a new Member Information Form."

p "I am joining as a passenger of the following rider:_____________________________________________________________

I will not be operating a motorcycle as an American Legion Rider, but may be participating in American Legion Rider events as a passenger. If my status changes, I will request, complete, and submit a new Member Information Form."

Signed: ______________________________________________ Date:_____________________________________________

All members must signify their understanding and certification of the relative section above by signing and dating here.

"I, the undersigned, agree that the American Legion, and the American Legion Motorcycle Association (henceforth referred to as ‘The American Riders’ or simply as ‘Riders’), shall not be liable or responsible for damage to property or injury to persons including myself during any Riders activities, even where the damage or injury is caused by negligence (except willful neglect). I understand and agree that all Riders members and their guest participate voluntarily, and at their own risk in all Riders activities. I release and hold the Riders officers and the American Legion harmless for any injury loss to my person or property that may result through my participation in the Riders and/or their activities. I understand that this means that I agree not to sue the Riders officers, whether local, state or national, nor the American Legion for any injury resulting to myself or my property in connection with and Riders activities.

Signed:___________________________________________________Date:_________________________________________

All members must signify their understanding of and agreement with the above by signing and dating here.

ALR Membership Number:_______________