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New Membership Application

Full Name(*)
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Address(*)
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City(*)
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State or Province
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Non-US Province
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Zip Code(*)
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Birthdate (mm/dd/yyyy)(*)
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Main Phone to contact you(*)
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Home Phone (123-123-1234)
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Mobile Phone 123-123-1234
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Email Address(*)
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Username(*)
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Password (At least 6 characters)(*)
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Password Confirm (Must Match)(*)
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Receive Diva Angels Email(*)
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Newsletter List(*)

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I would like to share my email address with other members of the Diva Angels (your email address is required).(*)
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Are you a motorcyle rider with a valid endorsement? (Required in Florida)(*)
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What do you ride?
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How long have you been riding?
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Have you completed a rider safety course?
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If so, where? (city+state)
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If Yes What Year was the course completed?
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How did you hear about us?
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If a member, please tell us their name?
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Do you have a friend you’d like us to contact?
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Friend’s Name
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Friend’s Phone
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What local chapter will you join?
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You must be 18 years of age or older to join.

INDEMNITY AND WAIVER AGREEMENT

I acknowledge and agree to accept the following by applying for membership and understand that if I choose not to accept the following I should not apply for membership in Diva Angels, Inc., a Florida not for profit corporation or its chartered chapters and their respective members, directors, employees and/or agents:

a I acknowledge that participation in this organization and any of its events is a voluntary act, which is recreational and naturally includes a degree of risk to personal safety and property; I voluntarily accept that risk and assume its consequences.

b In consideration for being permitted to apply for membership and/or for becoming a member of Diva Angels, Inc. I, for myself, my spouse, my children, my legal representatives, heirs and assigns hereby and for all purposes agree with Diva Angels, Inc. as follows:

i) That Diva Angels, Inc. shall not be liable for and I hereby release, discharge and acquit Diva Angels, Inc., for any and all claims for loss, damage or injury of any nature whatsoever to person or property resulting in anyway from or in any fashion arising from, connected with or participating in membership with Diva Angels, Inc. and their events, whether caused, in whole or in part, by negligent acts, simple or gross, of Diva Angels, Inc., its chartered chapters and their respective agents, members, officials, directors, servants, motorcycle owners, drivers sponsors, advertisers, employees or otherwise ("Released Parties").

ii) That I shall indemnify Released Parties from any loss, liability, damage, or costs that Released Parties may incur due to my actions, participation, or presence during my membership with Diva Angels, Inc. or their chartered chapters and the events put on by Diva Angels, Inc. and/or its chartered events.

iii) That I assume full responsibility for the risk of bodily injury and/or death and;/or property damage due to the negligence, simple or gross, of Released Parties or others while participating in Diva Angels, Inc. or its chartered chapters events.

iv) That I HEREBY RELEASE WAIVE, DISCARGE AND COVENANT NOT TO SUE, Released Parties, from all liability to the undersigned, his/her personal representatives, assigns, heirs and next of kin for all loss or damage, and any claim or demands therefore, on account of injury to the person or property or resulting in death of the undersigned, whether caused by the negligence, gross or simple, or Released Parties or otherwise while the undersigned is a Member of Diva Angels, Inc. or its chartered chapters.

v) That I HEREBY ASSUME FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE due to negligence, simple or gross, of Released Parties or otherwise while participating as a member of Diva Angels, Inc. or while competing, officiating in, observing, working or for any purpose participating in event's hosted by Diva Angels, Inc. or its chartered chapters.

c Your membership in Diva Angels, Inc. does not in any way include or guarantee to you any insurance coverage of any kind.

d THE APPLICANT expressly acknowledges and agrees that the activities inherent with membership in Diva Angels, Inc. are very dangerous and involve the risk of serious injury and/or death and/or property damage. Knowing this I further expressly agree that the foregoing release, waiver and indemnity agreement is intended to be as broad and inclusive as permitted by the laws of the Sate of Florida, and that if any portion thereof is held to be invalid, it is agreed that the remaining portion or portions shall continue in full legal force and effect.

By completing my membership application, and checking the Agree box below, I AGREE THAT I HAVE READ THE ABOVE AND VOLUNTARILY AGREE TO BE BOUND BY ALL MATTERS STATED ABOVE. I further acknowledge that no oral representations, statements, or inducements apart from the foregoing written agreement have been made.

Agreement Confirmation(*)
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Signature(*)
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New Membership Fee $20.00

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