Durham Diva Online Application

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Application Form

Membership Type: Please note, most fields are required. New $40
Renewal $30
Type of Application Rider
Non Rider
Name:
Address: Please include City & Postal Code
Email Address:
DOB: MM/DD Year is not necessary
Phone: please indicate if home or cell
How long have you been riding your own motorcycle? indicate N/A for Non-Rider
What make is your motorcycle?
What model is your ride?
Current Mileage: assume in KM's
Do you agree to have your name or photo published on the Public site MSN spaces? First & Last Name
First Name
Photo only
Photo with Name
Do you agree to have your name, email address and/or photo published on the Private web site for members only? Yes
No
The following information will be held in the strictest of confidence and will be used only through the result of an EXTREME EMERGENCY.
In case of an emergency, who would we notify?
Emergency Contact Relationship:
Emergency Phone # (if related give other # than home)

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By submitting this form your Application is considered as signed.

I / We understand and agree that this application is subject to the policies, rules, and regulations of Durham Divas Club, in force at this time or at any time in the future. I / We hereby agree to and will pay membership dues in the amount determined by the executive committee of Durham Divas.
RELEASE OF ALL LIABILITY AND INDEMIFICATION AGREEMENT:In consideration of the privilege of submitting this application, I / We do hereby for myself / ourselves and for my / our children under the age of twenty (20),  my / our heirs, executors, administrators, and successors, assign, release and forever discharge the Durham Divas Club,  its officers, directors, and agents from any and all losses, claims, demands, actions, suits at law and in equity,  judgments and executions which I / We  had, now have, or may in the future have, arising from or by reasons or any and all bodily or personal injuries whether known or unknown, death, and / or property damage resulting from, in connection with or rising out of social events, social gatherings, social functions, motorcycle and / or other trips, travel to and from and / or other activities, and any other motorcycle activities, and any and all other motorcycle activities, and any other activities of any kind or description in any way connected with the Durham Divas Club.
I / We acknowledge that the sport of motorcycling is a dangerous activity that can result in personal or bodily injury, included but not limited to or loss of personal property, including but not limited to,  motorcycle equipment. Furthermore, in consideration for the privilege in submitting this application, I / We on behalf of all family members under the age of twenty (20) listed above, and on behalf of my / our and their heirs, executors, administrators, or assigns, hereby agree to and will indemnify the Durham Divas Club, its officers, directors, and its agents and hold them harmless from any suits, filing fees, costs of collection, and attorney fees.
I / We have read the foregoing APPLICATION AND RELEASE OF LIABILITY AND INDEMNIFICATION AGREEMENT and understand all of the terms thereof. I / We execute it voluntarily and with full knowledge of its significance.