*First Name:
*Last Name:
*E-mail Address:
*Phone: This is a mobile number.
*Date of Birth: Month January February March April May June July August September October November December Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912
*Address:
*City:
*Postal Code:
*Have you been to a Garage Party™ event at a Harley-Davidson® Retailer? Yes No
*Do you have a valid motorcycle licence? Yes No – but I plan to get one No – not interested
*Do you own a motorcycle? Yes No
*What motorcycle brand(s) do you own?
*When do you plan on purchasing a new motorcycle? Less than 3 months 3 to 12 months Over a year Not sure Never
*Is Harley-Davidson® a brand that you will consider when you are ready to purchase? Yes No
*What is your annual household income? Select an Option Under $30,000 $30,000-$49,999 $50,000-$74,999 $75,000-$99,999 $100,000-$149,999 Over $150,000
*What is your relationship status? Single Dating Married Divorced
*Do you have children? No children. Yes, children under 13 years of age. Yes, children between 13-19 years. Yes, children over 19 years of age.
*Where did you hear about the Garage Party™ contest? Select an Option Harleycanada.com Facebook ad Facebook invite Sweetspot.ca Contest site Friend Harley-Davidson® Retailer Other
*I agree to the official rules and regulations.
I further acknowledge that my personal information may be used, processed or stored outside of Canada and may be accessed by governmental authorities according to the laws of that jurisdiction. By providing personally identifiable information, such as your name and contact information (“Information”) on this form, you consent to the collection and use of the Information by any of Fred Deeley Imports Ltd., d.b.a. Deeley Harley-Davidson® Canada, its Retailers, Harley-Davidson Motor Company Inc. and Harley-Davidson Owners Group® of Canada, for marketing and research purposes or to send you Harley-Davidson®/Buell™ branded products, programs and services information.
If, at a later date, you would prefer that we not continue to use the Information for the purposes set out above, please fax your request to 604-273-2029, Attention: Privacy Officer. You may view the Deeley Harley-Davidson® Canada Privacy Policy on our website.
*I consent to such use by Deeley Harley-Davidson® Canada.
