AMA LongRider Application
AMA LongRiders must provide verification information and program registration fee with this application.
Name
*
First Name
Last Name
AMA Number
*
Years Riding
*
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Year/Make/Model of Motorcycle 1
*
Years Owned
*
Odometer
*
Click here to add additional motorcycles.
Year/Make/Model of Motorcycle 2
Years Owned
Odometer
Year/Make/Model of Motorcycle 3
Years Owned
Odometer
Year/Make/Model of Motorcycle 4
Years Owned
Odometer
Year/Make/Model of Motorcycle 5
Years Owned
Odometer
Year/Make/Model of Motorcycle 6
Years Owned
Odometer
Signature (I certify that the milage above is true and accurate)
*
Date Submitted
*
-
Month
-
Day
Year
Verification Documentation (Choose One and Attach)
*
Odometer Photo (Include AMA Card in Photo)
Club Verification/Award
Dealer Letter/Service Document
Upload Verification Documentation
*
Browse Files
Drag and drop files here
Choose a file
10 MB total upload size. File types accepted (pdf, doc, docx, zip, jpg, jpeg, png, gif)
Cancel
of
Payment Information
*
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Registration
Includes 1 AMA LongRider Patch and 1 Decal
$20.00
$
20.00
Additional Patches
$7.50
$
7.50
Quantity
1
2
3
4
5
6
7
8
9
10
Additional Decals
$5.00
$
5.00
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card
First Name
Last Name
Credit Card Number
Security Code
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
Expiration Year
Submit
Should be Empty: