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Annual Tribute Ride to Darryll M Ceccoli

ALL RIDERS

WELCOME!SATURDAY, MAY 5

RAIN OR SHINE

ALL PROCEEDS BENEFIT CHILDRENS HEALTHCARE OF ATLANTA CARDIAC RESEARCH

9:30 AM

REGISTRATION

11AM

RIDE BEGINS

Escorted ride will begin and end at

Killer Creek Harley-Davidson, Roswell, GA

FREEGift Bag and T-Shirt

for the First 50 Riders Registered!

1 to 4 PMMusic b y Mike Wat so n

& Refreshments

www.ride4research.net | info@ride4research.net | www.facebook.com/choaride4research

$35 PER RIDER $15 COMPANIONRIDERMEND HEARTS. GIVE HOPE.

http://www.ride4research.net/mailto:info@ride4research.netmailto:info@ride4research.nethttp://www.ride4research.net/

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UNION HILL EXCHANGE, LLC, STATEMENT OF POLICIES REGARDING RIDE4RESEARCHThis document sets forth the policies of Union Hill Exchange, LLC, a Georgia Limited Liability Company,with regard to the annual event known as the Steel Horse Ride4Research and any other rides or eventssponsored by Union Hill Exchange, LLC (hereafter referred to as the Ride) in order to facilitate a smoothRide and to promote the safety of the participants in the Ride.1. Every participant who will operate a motorcycle in the Ride (hereafter the Driver or Drivers) mustfurnish his/her own motorcycle and be familiar with the operation of that motorcycle.2. All Drivers must be at least eighteen (18) years of age and have a valid license to operate amotorcycle.3. All Drivers must have a motorcycle endorsement on their drivers license. 4. All Drivers must provide proof of insurance covering their operations of their motorcycle in order to be aDriver in the Ride.5. All companion riders (hereafter Companion or Companions) must be at least twelve (12) years ofage or older, and any Companions who are under the age of eighteen (18) must be accompanied by a

parent or guardian.6. No one under the age of 21 years of age will be permitted to operate any official Ride vehicles orsponsor-supported vehicles. No one will be permitted to operate any official Ride vehicles or sponsor-supported vehicles unless they are listed on the Rides insurance policy.7. All Drivers and Companions (collectively referred to as Participants) must operate their motorcycles ina safe manner at all times, as judged in the sole and exclusive judgment of Ride personnel, and mustfollow any and all instructions given by Ride personnel regarding riding matters. Such instructions mayinclude, but not be limited to, terminating the Drivers participation in the remainder of t he Ride orinstructing a Driver that he/she must ride in the back of the pack for the remainder of the Ride.8. All Participants must wear helmets at all times while riding their motorcycles during the Ride. Thisrequirement applies regardless of whether the laws of a particular state require the use of helmets whilein that state.9. All Ride forms must be completed and signed before the ride begins. Application forms must beaccompanied by the full payment of participation fees in the amount set f orth in the application and theParticipants agreement to be subject to all policies set forth herein. If an application or participation feesare not received by the Ride start time, the applicant will not be able to participate in the Ride.10. Participation in the Ride is a non-transferable right. Participants will not be allowed to transfer theirspot on the Ride to another individual.11. The use of any form of alcohol or illegal drugs by Participants while driving in the Ride is strictly

prohibited.12. If an accident or injury occurs during the Ride, the accident or injury must be reported to Ridepersonnel within 24 hours of the accident or injury.13. Ride personnel reserve the right to instruct a Participant to comply with these policies, to condition aParticipants continued participation in the Ride on any conditions deemed suitable by Ride personnel intheir sole and exclusive discretion, to reject any application, and to terminate any Participantsparticipation in the Ride at any time (whether before or after the Ride has begun) for any reason. TheRide is not obligated to give a refund of any portion of any fees in the event that the Ride exercises any ofits rights under this provision or these policies.14. The waiver of any of the policies set forth herein in any particular circumstance shall not beconsidered a waiver of the policy for any other circumstance.15. In the event of any dispute about any application for or participation in the Ride, the Participantsremedies against the Ride will be limited to a refund of fees. As a condition of application andparticipation, all Participants must agree in the application form to waive any other damages other thanthe refund of fees paid as set forth in this paragraph.MOTORCYCLES MUST BE REMOVED FROM THE FINAL RIDE LOCATION BY 10PM. BIKES LEFT AFTER 10 PM WILL BE TOWED ORIMPOUNDED.

SAFETY IS THE PRIMARY CONCERN OF CHILDRENS HEALTHCARE OFATLANTA AND THE RIDE4RESEARCH. PLEASE OBSERVEALL FEDERAL,STATE AND LOCAL LAWS AND RIDE SAFELY AND DEFENSIVELY . CHILDRENS HEALTHCARE OFATLANTA AND THE

RIDE4RESEARCH REQUIRE THAT YOU WEAR A HELMET , APPROPRIATE CLOTHING AND EYEWEAR, AND THAT YOUR PASSENGERDOES ALSO. GEORGIA LAW STATES THAT NO PERSON SHALL OPERATE OR RIDE UPON A MOTORCYCLE UNLESS HE /SHE ISWEARING PROTECTIVE. PLEASE RIDE WITH YOUR HEADLIGHT ON AT ALL TIMES AND NEVER RIDE UNDER THE INFLUENCE OF

ALCOHOL OR DRUGS.In consideration of CHILDRENS HEALTHCARE OFATLANTA,RIDE4RESEARCH,UNION HILL EXCHANGE AND KILLER CREEKHARLEY-DAVIDSON, permitting (me) (my child who is under the age of 18) to participate in the above mentioned event, Ihereby and for (my) (my childs) heirs, executors, administrators, assigns, and all legal guardians, WAIVE AND RELEASE ANY

AND ALL RIGHTS AND CLAIMS OF ANY NATURE, FOUNDED IN WHOLE OR IN PART UPON ANY TYPE OF NEGLIGENCE, that (I) (Mychild) may have against CHILDRENS HEALTHCARE OFATLANTA,RIDE4RESEARCH,UNION HILL EXCHANGE AND KILLER CREEKHARLEY-DAVIDSON, its board of directors, officers, employees, sponsors, agents, chapters, assignees, licenses, volunteersand any cooperating entities, its representatives, heirs, executors, administrators, successors, and assigns (the ReleasedParties) arising out of or resulting from any and all injuries or damages of any nature, including death, which (I) (my chil d)may suffer while taking part in the event or any activities connected with the event. This release extends to any and allclaims (I) (my child) have or may have against the Released Parties, whether such claims result from negligence on thepart of any or all of the Released Parties with respect to the event or any related activities or with respect to the conditions(including but not limited to road, weather and traffic conditions), qualifications, instructions, rules, procedures and routesunder which the event and related activities are conducted, or from any other cause.(I AM)(MY CHILD IS) EXPERIENCED AND FAMILIAR WITH THE OPERATIONS OF MOTORCYCLES AND FULLY UNDERSTANDS THERISKS AND DANGERS INHERENT TO MOTORCYCLING.(I) (my child is) voluntarily participating in the event and I expresslyagree to assume sole responsibility for the safe and successful operation of my motorcycle, and to accept the entire risk ofany accidents or personal injury, including death, which (I) (my child) might suffer as a result of my participation in theevent. I further understand the (I) (my child) assume(s) all risks in participating in the event. I UNDERSTAND THAT THIS

MEANS THAT I AGREE NOT TO SUE any or all of the Released Parties in connection with the event. Consent also herebygiven to use (my) (my childs) name, picture, portrait, likeness, writings or biographical information and audiotape and/orvideotape recording and sound or silent motion pictures of (me) (my child) in any medium for editorial, educational,promotional, and advertising purposes, for the solicitation of contributions, and/or for any other purpose in furtherance ofthe corporate purposes and objectives of CHILDRENS HEALTHCARE OFATLANTA,RIDE4RESEARCH,UNION HILL EXCHANGE

AND KILLER CREEK HARLEY-DAVIDSON.By signing this document, I certify that I have read this document and fully understand it, and that I am not relying on anystatements or representatives of any of the Released Parties. This document shall be binding upon (me) (my childs) heirs,executors, administrators and assigns and all legal guardians (of my child).

____________________________________________________________________________________

Signature (Required)

____________________________________________________________________________________Print Name Date

RIDER INFORMATION (PLEASE PRINT CLEARLY)

___________________________________________Name Amount Paid (C/C

___________________________________________Address

___________________________________________City / State / Zip

___________________________________________Home Phone Cell Phone

___________________________________________E-mail Address

___________________________________________VALID MOTORCYCLE LICENSE REQUIRED Motorcycle License # State

___________________________________________Signature Date

COMPANION RIDER INFORMATION

___________________________________________Name Amount Paid (C/C

___________________________________________Address

___________________________________________City / State / Zip

___________________________________________Home Phone Cell Phone

___________________________________________E-mail Address

___________________________________________Signature Date

PAYMENT OPTIONS

(1) Enclosed is my check in the amount of $___________. ($35 rider, $15 companio

MAKE CHECKS PAYABLE TO:

Childrens Healthcare of Atlanta or CHOAMemo Line: Ride4Research

(2) Bill myVisa orMasterCard in the amount of $________________

___________________________________________Card#

___________________________________________Expiration Date Security Code (3-digit number on back of card)

___________________________________________Card Holders Signature

Mail checks and completed applications to:Ride4Research Coordinator100 Sugar Lake DriveCanton, Georgia 30115

Fax credit card authorization and completed applications to:Ride4Research Coordinator770-752-8799 (fax line only)

Ride4Research 2012 - Steel Horse Ride Application & Release Form (v3 March 2012)

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Ride4Research 2012 - Steel Horse Ride Application & Release Form (v3 March 2012)

Raise funds for Ride4Research by having family, friends, co-workers, neighbors and businesses sponsor you to ride in

the 2012 Steel Horse Charity Ride. All proceeds benefit the Darryll M Ceccoli Cardiac Research Fund at Childrens

Healthcare of Atlanta.

___________________________________________________________ $_________

Rider Name Total Amount Collected

Sponsor Names: Amount Collected: __________________________ _______________

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Rider Sponsor Form

Every dollar counts!

How you can raise $250:

Ask 4 relatives for $20..$80

Ask 4 friends for $10 .$40

Ask 4 co-workers for $5$20

Ask 5 neighbors for $10$50Ask 3 businesses for $20.$60

Total Raised..$250