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2026 Bill Werner AMA Fast Brain Award Application
Contact Information
AMA Member Number
Birth Date

MonthDayYear
First Name
Last Name
E-mail
Contact Number
Format: (000) 000-0000.
Website (if applicable)
Rider Address
Street Address
Address Line 2
City
State
Zip Code
Country
Biographical Information
School Attending
Grade
Grade Point Average (Official Report Card or Transcript Required)
Please attached Official Report Card or Transcript

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Check all classes you are competing in:
List bike number(s) with associated class:
Certification
I agree that the above information may be used for media purposes pertaining to the AMA Flat Track Grand Championship.
Signature
To be eligible for the 2026 Fast Brain Award, you must complete and submit this form no later than June 26, 2026.

SUBMISSIONS/INQUIRIES: Ken Saillant - ksaillant@ama-cycle.org - (614) 856-1900, ext. 1260
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2026 Bill Werner AMA Fast Brain Award Application