NAME: __________________________________________________________________________

ADDRESS: _______________________________________________________________________

CITY: __________________________________________ STATE: ___________ZIP: ___________

PHONE: _____________________________________ CELL: ______________________________

POST/UNIT/SQUADRON/NUMBER: ___________________ DISTRICT NUMBER: ______________

MEMBERSHIP NUMBER: _______________________________________________________         

LEGIONNAIRE: _______________ AUXILIARY: ________________ S.A.L. ___________________

BIRTHDAY: __________________________ E-MAIL ADDRESS: ____________________________

THIS IS A DISCLAIMER, READ BEFORE SIGNING

I agree that the American Legion and the American Legion Riders shall not be liable or responsible for damage

to property or any injury to persons including myself during any American Legion Riders events, even where the damage is caused by negligence (except willful neglect). I understand and agree that all American Legion Rider members and their guests participate voluntarily and at their own risk at all American Legion Riders events. I release and will not hold American Legion Rider Officers and the American Legion responsible for any injury or

loss to my person or property, which may result there from. I understand this means that I agree not to sue the American Legion Rider Officers and/or the American Legion for nay injury resulting to my property or self, in connection with any American Legion Rider events.

I also agree that acceptance of membership to the American Legion Riders defines that if I choose not to

renew my membership, or I am “Dropped from the Roles” for any reason, all items associated with the

American Legion Riders (i.e. patches, belt buckles, T-shirts, hats pins, etc.) will be returned to the

American Legion Riders, once I am no longer a member.

THIS WITH NO REFUND TO THE MEMBER

SIGNATURE: _____________________________________________DATE: __________________

AMERICAN LEGION RIDERS                                                                                          DISTRICT

MEMBERSHIP NUMBER: _______________________  NUMBER: __________________________

AMERICAN LEGION RIDERS RECEIPT OF DUES

MEMBER NAME: _____________________________________________ DATE: _______________

RECEIVED BY: _______________________________________ DUES AMOUNT: ______________