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H. O. G. MILEAGE RECOGNITION FORM SEE OTHER SIDE FOR PARTICIPATION FORM Get riding And while you re at it earn pins patches and motorcycle medallions all for riding your Harley-Davidson motorcycle 1. Participation is offered exclusively to all active H. O. G. members. 2. Mileage Recognition includes only Harley-Davidson motorcycles. 3. Enroll by completing this form. 4. Your VIN Vehicle Identification Number and current mileage must be on the form. 5. 3. Enroll by completing this form. 4. Your VIN Vehicle Identification Number and current mileage must be on the form. 5. All forms must be endorsed by a Harley-Davidson dealer. 6. IMPORTANT NOTE Each motorcycle must be enrolled prior to accumulating miles in Mileage Recognition. 7. M I L E A G E A C H I E V E M E N T P I N S A N D PA T C H E S A R E E A R N E D BY REACHING THE FOLLOWING LEVELS MILES KILOMETERS 10 000 16 100 25 000 40 250 40 000 64 400 60 000 96 600 80 000 128 800 201 250 241 500 175 000 281 750 200 000 322 000 483 000 Special medallions and rockers suitable for placement on your Harley-Davidson motorcycle will be awarded for each 100 000mile achievement. Awards continue beyond the 300 000-mile level at 100 000-mile increments. NOTE To convert kilometers to miles divide kilometers by 1. 61. MAIL FORM TO H. O. G. Mileage Recognition P. O. Box 453 Milwaukee WI 53201-0453 FAX 414-343-4515 Rider Email First Name Last Name Street Address City State Home Phone Number H. Participation is offered exclusively to all active H. O. G* members. 2. Mileage Recognition includes only Harley-Davidson motorcycles. 3. Enroll by completing this form* 4. Your VIN Vehicle Identification Number and current mileage must be on the form* 5. All forms must be endorsed by a Harley-Davidson dealer. 6. IMPORTANT NOTE Each motorcycle must be enrolled prior to accumulating miles in Mileage Recognition* 7. Harley-Davidson Authorized Rentals mileage may be credited by submitting a copy of the contract indicating mileage. M I L E A G E A C H I E V E M E N T P I N S A N D PA T C H E S A R E E A R N E D BY REACHING THE FOLLOWING LEVELS MILES KILOMETERS 10 000 16 100 25 000 40 250 40 000 64 400 60 000 96 600 80 000 128 800 201 250 241 500 175 000 281 750 200 000 322 000 483 000 Special medallions and rockers suitable for placement on your Harley-Davidson motorcycle will be awarded for each 100 000mile achievement. Awards continue beyond the 300 000-mile level at 100 000-mile increments. NOTE To convert kilometers to miles divide kilometers by 1. 61. MAIL FORM TO H. O. G* Mileage Recognition P. O. Box 453 Milwaukee WI 53201-0453 FAX 414-343-4515 Rider Email First Name Last Name Street Address City State Home Phone Number H. O. G* Number ZIP including Country Code Passenger Email VIN Vehicle Identification Number FILL OUT THIS SECTION TO ENROLL START IN THE MILEAGE RECOGNITION OR ADD ADDITIONAL BIKE S VIN Current Odometer Miles Kilometers REPORT MILEAGE FOR ENROLLED BIKE S OR FOR BIKE S SOLD NOTE An entry should be made in both sections above to report a vehicle trade.

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