NAME: ________________________________________________________

(CHECK BOXES ONLY FOR ITEMS NOT TO BE INCLUDED IN THE MEMBERS-ONLY CLUB ROSTER)

MEMBERSHIP DUES:

U.S. $20 PER YEAR.  ALL MEMBERSHIPS EXPIRE DECEMBER 31.  IF JOINING AFTER JULY 1, PLEASE ADD US $10 FOR THE NEXT CALENDAR YEAR.

TOTAL ENCLOSED: U.S. $_____________

PAYMENT BY CASH, MONEY ORDER, OR CHECK, (IN US FUNDS ONLY!). MAKE CHECKS TO:  VOCNA

SEND APPLICATION AND PAYMENT TO:

       VOCNA C/O DICK CASEY                               

        13029 S.W.BACHELOR ROAD

          VASHON, WA, 98070,  USA

        Release of Liability, Indemnification, and Hold Harmless Agreement

I hereby agree, as a condition of my membership and participation in the Velocette Owner’s Club of North America (VOCNA) that I will be responsible for my own actions and those of all  minors in attendance with me at any VOCNA event; and release, indemnify, and hold harmless the VOCNA and its members, officers, and agents, the organizers of any VOCNA event, and other participants in any VOCNA event, from any and all claims, demands, losses, injuries, expenses, damages, to persons or property, or liability of any kind arising out of my participation and attendance at any VOCNA event.

SIGNATURE: ___________________________  DATE: _______________

YOUR APPLICATION CANNOT BE ACCEPTED WITHOUT YOUR SIGNING THE ABOVE AGREEMENT.