LongRider Award Request

AMA LongRider Award Request

AMA LongRiders must be registered prior to requesting awards. No awards will be sent without payment, prior registration, and proof/verification.
Name

First NameLast 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

CityState / Province

Postal / Zip Code
Year/Make/Model of Motorcycle 1
Years Owned
Odometer

Signature (I certify that the milage above is true and accurate)

Clear
Date Submitted

MonthDayYear
Verification Documentation (Choose One and Attach)
Upload Verification Documentation

10 MB total upload size. File types accepted (pdf, doc, docx, zip, jpg, jpeg, png, gif)
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AMA LongRider Award Request