Statement of Waiver

HSR Statement of Waiver

HSR Statement of Waiver

I/We _________________________________do hereby agree to Indemnify and hold harmless GLD dba as "Harley Shootout Rally" and their respective officers, agents and members of any sponsoring organization or business and underwriters, individually or collectively, from all fined, penalties, liabilities, losses, claims, damages, and expenses including court costs and attorney fees, incurred or suffered as a result to my application and/or participation in the event known as Harley/Buell Shootout Rally August 23rd - 24th 2008. I/We have obtained all the necessary licenses/permits and insurance required by any State or Local Government in regards to my participation in this event.

Signature: _______________________________________________________________

Date: ___________________________________

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