New Membership Form

ESSEX Chapter New Membership/Renewal Application Form

(Annual Renewal Date – 1 January) Please PRINT CLEARLY all details

If Renewing Please Include Your Membership Number

First Member Name:

Date of birth:

Joint Member Name: (If applicable)

Date of birth:

Address:

Postcode:

Home Phone Number:

Mobile Phone Number:

Full Member Email address (please print CLEARLY):

Joint Member Email address (please print CLEARLY):

Harley Davidson or Buell Model:

Bike Registration number:

Essex Chapter GB is a group of Harley Davidson motorbike owners and enthusiasts. Please read this declaration, the disclaimers, and code of conduct before signing.

Declaration: I accept that the information contained on this application form will be stored on a computer database. The nominated Chapter membership secretary will maintain the database. The information contained is for Essex Chapter use only and will not be used for any purpose other than normal Chapter business. The information will not be transmitted to any third party outside of the Chapter.

Ride Disclaimer: Essex Chapter Great Britain (referred to as the Chapter), its directors, officers and representatives accept no legal liability for accident, injury, loss or damage incurred whilst riding on an organised Chapter ride out or at any other time. You are responsible for your own safety at all times. Whilst ride leaders or road captains will give you indications of actions to be taken i.e. 2nd rider drop offs, it is and must remain your decision whether and where to stop to ensure both the safety of yourselves and other road users. You are responsible for your own safety at all times. If a road captain feels that your riding represents a danger to you or any other road user, you will be asked to leave the ride out - this is not negotiable. All participating riders are responsible for maintaining valid insurance in respect of Third-Party loss or damage, valid MOT certificate [where applicable] and to ride within all statutory laws and regulations applicable under the relevant Road Traffic Act.

Disclaimer: Essex Chapter is an independent entity responsible for its actions. All members and their guest[s] participate voluntarily and at their own risk in Chapter activities. All Chapter Officers are and shall be released and held harmless by the member/guest for any injury or loss to the member/guest or to his or her property which may result from participation in Chapter activities. This means that each and every member of the Chapter and their guest[s] have no grounds for legal action against the Chapter, its Officers and their respective agents and employees for any injury resulting to them or their property.

Code of Conduct: • Treat everyone with respect • Treat each member as you wish to be treated yourself • Be tolerant • Respect the beliefs and views of others even when not in line with yours • Honour the Chapter Charter and By-Laws

Newsletters, ride-out updates, and other information is generally provided by email or on the website.

Please Select:

By signing this application form I certify that I have read the above declaration, disclaimers, and code of conduct and fully understand and agree with them and I am not relying on any statements or representations made by Chapter Officers. Members Signature: (Also, on behalf of Joint Members)

Date:

Any Additional Info As Listed Below:

Please make payment by BACs to Sort Code: 30-92-93 A/c No: 70331768 Ref: New Membership

Cheques payable to: Essex Chapter GB Send completed form and cheque to: Essex Chapter Membership, 9 Reymead close, West Mersea, Essex. CO5 8DH.

ESSEX Chapter

Please can you provide a few details about your riding history:-

How long have you been riding?

How long have you owned a Harley?

Have you ridden in a group large or small?

To assist the Chapter with continuous improvement, future planning and Admin please provide the following information (voluntary)

Please mark all that apply.

What appeals to you about the Chapter.

1. Already know some members

2. Diversity/No of events per year

3. Was a previous member (Hog)

4. Attending a Chapter event

5. Social Events

6. Tours/Rideouts

7. Other (Please state)

Where/how did you find out about the Chapter

1. Web search

2. Forum

3. Event (Where?)

4. Facebook/social Media

5. Recommendation (Who/Where?)

6. Word of mouth

7. Dealership

8. Other (please State)

Additional comments ?

Many Thanks for your assistance with this info

ESSEX Chapter New Membership/Renewal Application Form

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