hosts the 12th annual motorcycle ride

to benefit the
GA Sheriffs Youth Homes
Saturday, September 19, 2015

Registration begins 8:30 a.m.

Paulding Senior Center
(54 Industrial Way N, Dallas, GA)
Kickstands up 10:00 a.m.
Pre-register by Sept. 8th
to guarantee t-shirt
$35 per bike
$15 per passenger

Ride will begin and end at Paulding Co

Community Center for lunch & drawings
For more information contact
Melanie Thompson at 770-505-5533


Lt. Tracy Parker or Major Tom Murphy
770-443-3010 www.paulding.gov/sheriff

I understand that Georgia Sheriffs Youth Homes and the Paulding County Sheriffs Of ice can not
assume responsibility for any aspect of my safety or the safety of my passenger, and that if I participate in any Georgia Sheriffs Youth Homes and Paulding County Sheriffs Of ice event I do so
voluntarily, on my assessment of my abilities, the condition of my machine, the routes and all
facilities and circumstances. I certify that I am duly licensed and competent to operate a motorcycle in a safe manner, and the vehicle is in a safe operating condition.

I further understand that I assume all risk for myself, my passenger and my property and
that I, the undersigned, give this release and waiver for myself, heirs, successors and representatives. I agree to release and to hold harmless Georgia Sheriffs Youth Homes and Paulding County
Sheriffs Of ice and all its related entities and all of their employees, agents and representatives
from any liability, loss, damage, costs, claims, lawsuits and /or causes of action including but not
limited to all bodily injuries, including death and property damage, arising out of any aspect of my
attending at or participation in any event associated with Georgia Sheriffs Youth Homes and
Paulding County Sheriffs Of ice. No matter whether on the premises where an event is being presented or while preparing for or participating in any activity associated with an event away from
the premises.


Signature ______________________________________________________________ Date ______________________

Registration Information
Riders Name:___________________________________________ T-shirt (M L XL XXL)
Address:________________________________________________________________
City, State, Zip:__________________________________________________________
Email:_________________________________ Phone: _________________________
Additional Riders Name:___________________________________Size: (M L XL XXL)
Extra t-shirt ($10): Yes No

Size: (M L XL XXL)

To guarantee a t-shirt all shirts must be pre-ordered by 9/8/15

** Make check payable to GA Sheriffs Youth Homes
Mail payment and registration to Paulding Co Sheriffs Office, Lamar Hunton Memorial Ride,
247 Industrial Way N, Dallas, GA 30132
IRS designated 501(c)(3) charity. 58-1310087