(All proceeds will go to Mountain Valley Hospice
and the Hospice & Palliative CareCenter in Winston-Salem)

Come and explore the Vineyards of the Yadkin Valley

Ride will begin and end at the Yadkin Valley Grape Festival

Name: _______________________________________________

Address:_____ ________________________________________

City: ____________________________________ State: _____ Zip: ____________

Contact Phone: _______________________________________________

Email address: _______________________________________________

Motorcycle: Make: ___________________ Model: __________________

Registration: _____ $25 for 1up *
_____ $15 for passenger *

* ( includes 1 T-shirt, and 1 ticket to wine tasting at Yadkin Valley Grape Festival and engraved wine glass. Participant(s) must be 21 or older for the wine tasting. Photo ID required.). Lunch will also be provided and all participants will be eligible for door prizes at end of ride.

Make checks payable to "Yadkin Chamber/GinnyB Ride" and in the memo section please put "Ginny B Memorial Motorcycle Ride to Benefit Hospice".

Please send checks/entry forms to: Yadkin County Chamber of Commerce
P.O. Box 1840
Yadkinville, NC 27055

RELEASE AND WAIVER OF LIABILITY
AND INDEMNITY AGREEMENT

IN CONSIDERATION for being permitted to participate in the 2010 Yadkin Valley Grape Festival "Ginny B Memorial Motorcycle Ride to Benefit Hospice" Motorcycle Ride.

THE UNDERSIGNED:
1. HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE the Yadkin Valley Grape Festival, Yadkin County Chamber of Commerce, the officers, directors, management, officials and volunteers assisting in the event, the sanctioning organization or any subdivision thereof, grounds operators, grounds owner, officials, promoters, sponsors, advertisers; owners and lessees of premises used to conduct the event and each of them, their officers and employees, all for the purpose herein referred to as "releasees," from all liability to the undersigned, his personal representatives, assigns, heirs, and next of kin for any and 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 of the releasees or
otherwise while the undersigned is participating in the event.

2. HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS
the releasees and each of them from any loss, liability, damage, or cost (including attorney's fees)
they may incur due to the presence of the undersigned participating in the event and whether caused
by the negligence of the releasees or otherwise.

3. THE UNDERSIGNED RIDER agrees that in order to participate in this event, undersigned
rider/driver must provide/present a valid operator's license and proof of personal injury and property
damage liability insurance coverage.

4. THE UNDERSIGNED FURTHER agrees that while participating in the event, he or she will not ride
while under the influence of alcohol or any substance which affects the ability to operate or control his
or her vehicle.

5. THE UNDERSIGNED AGREES that he or she will not use or operate any vehicle in violation or
contravention of any City, County, State or Federal laws, statutes, ordinances or regulation and shall
be personally liable for all fines and penalties for traffic law violations.

6. THE UNDERSIGNED RIDER agrees to wear minimum safety apparel as required by state law.
Minimum safety apparel for these purposes may include a DOT approved safety helmet. Rider is
strongly advised to wear a helmet whether required to do so by law or not, and is strongly advised to
wear glasses, goggles, or a face shield, and additional protective outerwear such as gloves, long-sleeved
jacket, boots and long trousers while participating in the event. Rider understands and
acknowledges that failure to wear proper safety apparel may result in the rider's injury or death.

7. HEREBY ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH OR
PROPERTY DAMAGE due to the negligence of releasees or otherwise while participating in the
event.

EACH OF THE UNDERSIGNED expressly acknowledges and agrees that the activities of the event
are dangerous and involve the risk of serious injury and/or property damage. THE UNDERSIGNED
further expressly agrees that the foregoing release, waiver, and indemnity agreement is intended to
be as broad and inclusive as is permitted by the law of the State in which it is operated in and that if
any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full
legal force and effect.

THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS THE RELEASE AND WAIVER OF
LIABILITY AND INDEMNITY AGREEMENT, and further agrees that no oral representations,
statements or inducements apart from the foregoing written agreement have been made.
THE UNDERSIGNED ALSO AGREES TO release the use of any photos, slides, videotapes, etc. that
might contain the UNDERSIGNED for future use in promotional and/or informational activities as
deemed appropriate by any of the releasees.

Signature of Rider Date / Signature of Passenger Date

_________________________________________________ _____________________

_________________________________________________ _____________________

MINORS: Minors under the age of 18 must have a parent or legal guardian present to sign written
waiver for each minor to participate and/or ride in the 2010 Yadkin Valley Grape Festival event. If
parent or legal guardian is not present, a notarized waiver must be supplied at registration. i.e. The
named person (name) on this notarized statement has my permission to sign the minor release and
waiver of liability for my minor child (name) to participate and/or ride in the 2008 Yadkin Valley Grape Festival "Ginny B Memorial Motorcycle Ride to Benefit Hospice" Motorcycle Ride event on October 16, 2010 in Yadkinville, NC. Signed by parent or legal guardian and notarized. No exceptions will be allowed.