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September 25th, 2010

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Operator
 
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Passenger
 
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Motorcycle Information
 
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Release of Liability

On my own behalf and on behalf of my heirs, personal representatives, successors and assigns, for and in consideration of the opportunity to participate today in the Lynnda Laubach Breast Cancer Awareness Ride (“Event Ride”) which is hereby acknowledged, hereby release and forever discharge Lynnda Laubach Breast Cancer Awareness Ride, Harley-Davidson, Inc., and Zylstra Harley Davidson, their respective officers, directors, employees and agents (“Released Parties”) from any and all claims demands, rights and causes of action of any kind whatsoever, whether known or unknown, which I now have or later may have against the Released Parties in any way resulting from, arising out of, or connected in any way to my participation in the Event Ride being held today and sponsored by Zylstra Harley-Davidson.

This Release extends to any and all claims I now have or may have against the Released Parties, even if such claims result from strict liability or negligence on the part of any or all of the Released Parties, if it concerns the design, manufacture, repair, or maintenance of the motorcycle(s) involved in the Event Ride, or if it concerns the conditions, qualifications, instructions, rules or procedures under which the Event Ride is conducted, or from any other cause. However, I am not releasing any released party from any intentional misconduct.

I hereby state that I am a licensed motorcycle operator, that I am experienced in and familiar with the operation of various motorcycles and the motor cycle I will be operating during the Event Ride, that I am familiar with the rules of the road, as applicable to motorcycles, and that I fully understand the risks and dangers inherent in motorcycling. I further state that I am covered by any and all insurance policies required under Minnesota or federal law and that such insurance coverage is effective on the date of the Event Ride. I am voluntarily participating in the Event Ride and I expressly agree to assume the entire risk of any accidents, property damage, or personal injury, including death, which I might suffer or which I might cause as a result of my participation in the Event Ride. I agree that I am participating in the Event Ride knowing the existing weather conditions, the existing road conditions, and the condition of the motorcycle I will be operating in the Event Ride.

BY PROVIDING MY NAME AND DATE BELOW, I AM SIGNING AND HEREBY ACKNOWLEDGE AND AGREE THAT I HAVE FULLY READ THIS RELEASE AND FULLY UNDERSTAND IT, THAT I AM VOLUNTARILY GIVING UP CERTAIN LEGAL RIGHTS AND THAT I AM NOT RELYING ON ANY STATEMENTS OR REPRESENTATIONS OF ANY OTHER PERSON BEFORE SIGNING THIS RELEASE. I FURTHER AGREE THAT I AM SIGNING THIS RELEASE OF MY OWN FREE WILL AND NOT UNDER ANY DURESS.

*Operator Name: *Date:
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