Membership Local Chapter Membership - $20.00pp Fields marked with an * are required Member Details Name * Known as Street address * City * Post code * Phone Numbers * Home phone Work phone Cellphone Texting service Email Used for emailing your monthly newsletter Post newsletters (additional $25 fee) Join Central Districts HOG Facebook page Ladies of Harley Details LOH can be member or partner of member Name Known as Street address City Post code Phone Numbers Home phone Work phone Cellphone Texting service Email Used for emailing your monthly newsletter and LOH specific notices Join Central Districts HOG Facebook page Chapter Central Districts 9112 Particulars of Harley-Davidson Motorcycle owned: Model * Year Rego * International HOG number * You MUST be an International Member to be eligible to apply for the local membership Expiry date * I have read the Annual Charter for Harley Owners Group (H.O.G.) Chapters and hereby agree to abide by it as a member of this independent local chapter of H.O.G. I recognise that while this Chapter is chartered with H.O.G., it remains a separate, independent entity solely responsible for its actions. I also agree that the sponsoring dealer, the Harley Owners Group (H.O.G.), Harley-Davidson Australia Pty Limited, Harley Davidson Inc., and my local chapter shall not be liable or responsible for any damage to property or injury to persons including myself during any HOG chapter event or activity, even when such damage or injury is caused by negligence (except willful neglect). I understand that, and agree all HOG members and their guests participate voluntarily and at their own risk in all HOG and HOG chapter activities. I release and hold the Sponsoring Dealer, HOG and Harley Davidson Inc. harmless for any injury or loss to my person or property which may result therefrom. I understand that this means I agree not to sue the Sponsoring Dealer, HOG or Harley Davidson Inc., for any injury resulting to myself or my property in connection with HOG or HOG chapter activities. I have read and agree to the release above. * Account # for internet banking 06 0729 0097716 00 (ensure you put your name as reference) (This form still needs to be submitted to Anza even if payment is made via the internet)
