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 Name
Last Name
AMA Number
*
Years Riding
*
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Make/Model of Motorcycle 1
*
Years Owned
*
Odometer
*
Click here to add additional motorcycles.
Make/Model of Motorcycle 2
Years Owned
Odometer
Make/Model of Motorcycle 3
Years Owned
Odometer
Make/Model of Motorcycle 4
Years Owned
Odometer
Make/Model of Motorcycle 5
Years Owned
Odometer
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)
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AMA LongRider Award Options (First Rocker Per Category is Free. Each Additional Rocker is $5.00. AMA LongRider Decals are $5.00)
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10,000/Year
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
25,000/Year
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
50,000/Year
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
25,000/Lifetime
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
50,000/Lifetime
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
100,000/Lifetime
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
250,000/Lifetime
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
500,000/Lifetime
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
750,000/Lifetime
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
1 Million/Lifetime
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
AMA LongRider Decal
$
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
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
Expiration Year
Submit
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