Address:

City: State: Zip:

Home Phone: Alternate Phone:

Registration for rider is $35.00, and $15.00 for passenger

Collect $100 in donations for a free ticket ($150 for driver and passenger). Click here to download your donation form. You do not have to ride to participate, just collect your donations or pay the rider fee. For each additional $250 collect you will receive an additional raffle ticket for the drawings!! Prizes include LoJack w/Early Warning for Motorcycles ($1200 value), various gift certificates for restaurants, auto remote start or alarm, auto details and much more!!

Once submitted, you will receive a response email with updates including ride and registration info. Payments should be made the day of the ride in the form of cash or money order. Personal checks are accepted, but must be received at least 2 weeks prior to the ride to allow time for to clear. You may prepay your registration fees using Pay Pal as well. Pay Pal is preferred due to ease of use and allows you to pay using a credit card. This is a charity ride, all proceeds are being donated to The Center for Infant & Child Loss (which supports the Maryland SIDS Program). All pre-registered participants, please bring a copy of this registration and relealse agreement form to the start of the ride. Sign in is 9 -10:30 AM June 8th, 2008 and start the ride from either location. You may register the day of the ride, but for an accurate event count we prefer pre registration.

I, ______________________________________________, am about to voluntarily participate in various activities concerning motorcycles. These activities include, but are not limited to, riding in a motorcycle event to support SIDS. This is a privately organized and sponsored event. I understand and acknowledge that the above activity may be dangerous. I agree to assume the risk of all personal injuries, death, dismemberment and property damage that may occur to, or involving me as a result of partaking in the above activities. I, on behalf of myself, my personal representatives, my heirs and my estate voluntarily agree to release, waive and hold harmless the JEM3 SIDS Ride organizers, event helpers, dealers, vendors and their agents, officers and employees for any and all claims arising from my participation in the above activities. I also grant the Team JEM 3 event organizers, volunteers and the CICL the right to take photographs of me and my property in connection with the above-identified event. I authorize Team JEM 3, CICL, it's assigns and transferee's to copyright, use and publish the same in print and/or electronically.
I agree that Team JEM 3 and CICL may use such photographs of me with or without my name for any lawful purpose, including for example such purposes as publicity, illustration, advertising and web content.

NO COLORS, NO ATTITUDES, NO PETS

I have read and understand the above:

_______________________________________________________________________

Signature of Rider (to be signed and submitted the day of the ride)

_______________________________________________________________________

Signature of Passenger (to be signed and submitted the day of the ride)

Please check off your start location.

I will be riding out of Elkridge/H-D of Maryland _____

I will be riding out of Gettysburg/Battlefield H-D _____

If you wish to change locations, please try to let us know in advance.

Date:_______________________