Please Do Not email this formů Complete/Print and Bring it with you when you join our Ride!
Last Name: First Name: Road Nickname: City where joining NVAR: Email: Street Address: City: State: Home Phone: Cell Phone: Would you like to be placed on our NVAR email information list? Zip: Apt. #: Emergency Contact Name: Relationship: Phone: Alternate Phone: Check ONE: Motorcycle Rider Motorcycle Passenger 4 Wheel Other Participant Yes

NVAR Registration Coordinator: Dan Kuepker (219) 380-9186

Please Do Not email this form - Complete/Print/Sign and bring it with you when you join our Ride!

As a condition of my voluntary participation in the National Veterans Awareness Ride (NVAR) for myself and my heirs and assigns, I hereby release and discharge the National Veterans Awareness Organization, its volunteers and agents and any affiliated organizations and their respective officers, volunteers and agents from any and all claims, demands, damages or liabilities arising from injury to my person or property as the results of participating in the NVAR.  I currently hold a valid drivers license with proper endorsement, and I have comprehensive motor vehicle liability insurance covering the vehicle that I will be operating during the NVAR.

Rider/Participant Signature Date: Release of Liability National Veterans Awareness Ride Registration Form (2018) Emergency Medical Information and Bike Disposition Information is the responsibility of the individual and should be carried at all times on your person and on your bike.

942 Green Street, Michigan City, IN 46360  Tel: (219) 873-5910