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Rider E-mail

First Name Last Name

Street Address

City State ZIP

Home Phone Number H.O.G. #

(IncludingCountryCode)

H.O.G.

MieaGe PrOGraM FOrM

FILL OUT THIS SECTION TO:

enrOl (STarT IN THE MILEagE PrOgraM)OraDD aDDitiOna bike(s) TO THE PrOgraM

VIN Starting Odometer Miles Kilometers

VIN Starting Odometer Miles Kilometers

Passenger E-mail

First Name Last Name

Street Address

City State ZIP

Home Phone Number H.O.G. # (IncludingCountryCode)

IMPOrTaNT NOTE: EachHarley-Davidsonmotorcyclemustbeenrolledpriortoaccumulatingmilesintheprogram.(VIN=VehicleIdentifcationNumber)

FILL OUT THIS SECTION TO:

rePOrt MieaGe FOr ENrOLLEd bIkE(S)Or FOr bIkE(S) SOLd

VIN Current Odometer Miles Kilometers

VIN Current Odometer Miles Kilometers

VIN Current Odometer Miles Kilometers

NOTE: Anentryshouldbemadeinbothsectionsabovetoreportavehicletrade.

dEaLEr ENdOrSEMENT (rEQUIrEd):

Dealer Name Dealer #

Dealer Signature Date

(I hereby certify that the information on this form is correct)

MaIL FOrM TO: HarleyOwnersGroupMileageProgram,P.O.Box453,Milwaukee,WI53201-0453

Or FaX FOrM TO: 414-343-4515 PHONE:1-800-CLUBHOG(1-800-258-2464)

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H.O.G.

MieaGe PrOGraM FOrM

gET rIdINg! aNd wHILE yOUrE aT IT, EarN PINS, PaTCHES aNd MOTOrCyCLE MEdaLLIONS

aLL FOr rIdINg yOUr HarLEy-davIdSON

MOTOrCyCLE!

1. ParticipationisoeredexclusivelytoallactiveH.O.G.members.

2. ProgramincludesonlyHarley-DavidsonandBuellmotorcycles.

3. Enrollbycompletingthisorm.

4. YourVIN(VehicleIdentifcationNumber)andcurrentmileagemustbeontheorm.

5. AllormsmustbeendorsedbyaHarley-Davidsondealer.

6. IMPOANNOE:Eachmotorcyclemustbeenrolledpriortoaccumulatingmilesintheprogram.

7. Harley-DavidsonAuthorizedentalsmileagemaybecreditedbysubmittingacopyothecontractindicatingmileage.

Mileageachievementpinsandpatchesareearnedbyreachingtheollowinglevels:

aWarD eVes Mies kiOMeters1,000 1,610

5,000 8,050

10,000 16,100

25,000 40,250

40,000 64,400

60,000 96,600

80,000 128,800

100,000* 161,000*125,000 201,250

150,000 241,500

175,000 281,750

200,000* 322,000*

250,000 402,500

300,000* 483,000*

*Specialmedallionsandrockers,suitableorplacementonyourHarley-Davidsonmotorcycle,willbeawardedoreach100,000-mileachievement.Awardscontinuebeyondthe300,000-milelevelat50,000-mileincrements.

NOE:oconvertkilometerstomiles,dividekilometersby1.61.

MaIL FOrM TO:

HarleyOwnersGroupMileageProgram,P.O.Box453,Milwaukee,WI53201-0453

FaX: 414-343-4515

PHONE:1-800-CLUBHOG(1-800-258-2464)