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START: 9:00 AM
Saterday, 29th August
2009
Hermy’s BMW
Rt 61 port Clinton, PA
ENTRY FEE: $35
Passenger $15
Walk-in $35
REGISTRATION is open
ENTRY FEES ARE NON-REFUNDABLE
FINISH: NO LATER THAN 7:30 PM that day
THE JOHN A. AYELLO RALLY IS A LONG-DISTANCE TOUR, NOT A RACE, AND WILL CHALLENGE
YOU TO COMPLETE A SCENIC ROUTE FEATURING MANY OF HAZELTON AREA BEST HIGH
COUNTRY BACKROADS AND MOUNTAIN PASSES.
THE OFF-ROAD/ADVENTURE (G.S.) Gelande Strasse RIDING, QUALIFIED
FINISHERS WILL RECEIVE A SPECIAL COMMEMORATIVE PPCA MEDALIAN IN RECOGNITION OF THEIR ACCOMPLISHMENT AND THE OPPORTUNITY TO
REGISTER WITH THE RALLY.
LIMITED TO 200 ENTRIES.
ALL BIKES ARE WELCOME.
COMPLETE EVENT AND HOTEL INFORMATION WILL BE MAILED UPON RECEIPT OF YOUR ENTRY.
ROUTE INSTRUCTIONS AND GPS down-loads WILL BE PROVIDED AT CHECK-IN. A LIMITED NUMBER OF HOTEL ROOMS ARE BEING
HELD FOR THE RALLY. SIGN UP EARLY TO ENSURE HOTEL AVAILABILITY.
This event is expected to sell out early, so
sign up now!
2009 MEMORIAL RALLY ENTRY FORM
Name: _______________________________________________________________________________________
(Please print)
Address: _____________________________________________________________________________________
City: _________________________________________________________
ST: _________ Zip: _____________
Phone: (______)_______________________
T-Shirt: S M L XL XXL (Circle size)
E-mail:_________________________________________
Emergency Contact Name and
Telephone: ________________________________________________________
Motorcycle: Make: _____________________________
Model: _____________________________ Yr: _________
Insurance Info: ___________________________
Name of Company:__________________________________
Drivers License Number:_________________________
License Plate Number:_______________ State:______
Male _ Female _ Driver _ Passenger _ If passenger, name of driver: _________________________________
Total amount enclosed:
$_________________
Mail entry with check payable to PPCA.
Mail to PPCA Rally C/O Susie Zeiner – 263 Fremont RD Nottingham, PA 19362
Terms: PA Police Canine Assoc (PPCA), Hermy’s
BMW and Tire Company Inc, Rausch Creek Trailriders, it's Owners, associates, agents and companies shall not be held responsible
for and shall accept no liability in respect of any claims, losses, damages, costs or expenses arising from personal injury,
sickness , disease, accident or death incurred during any rally events, motorcycle tour, however caused, without limitations.
Loss or damage to baggage, or other property caused by weather, equipment failure or any other causes will not be the responsibility
of PPCA, Hermy’s BMW and Tire Company Inc, Rausch Creek trailriders. We
reserve the right to decline or refuse any person participation in our rally should they not conform to rally guidelines or
terms. Waiver Agreement: I Understand and accept the terms, conditions and information contained herein. I hereby accept all
risks of personal injury and property damage arising from my participation in this tour and I agree that myself, my dependents,
heirs, executors do indemnify PPCA, Hermy’s BMW and Tire Company Inc, Rausch Creek Trailriders and its employees, owners,
directors and representatives against any and all claims or costs. Further, by signing this form, I certify that if I am a
licensed motorcycle operator and that I hold a currently valid, state issued motorcycle operator’s license. I understand
that I will wear a helmet in the states where it is required by law, and when in states where helmet use is optional I understand
the choice of wearing a helmet or not, is solely my own.
I have fully read and agree to abide with the Terms
and Release of Liability as stated above.
Signature: ________________________________
Date: ________________
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