The American Motorcycle Rally Rider Application

I have read and accept the Terms and Conditions above. Click here for a printable version in a new window.

I have read and accept the Waiver and Release above. Click here for a printable version in a new window.

Rider Information

Riders will become obligated as set forth herein after the submission of this application along with the Waiver & Release of Liability and Terms & Conditions. Please read each document thoroughly and do not sign and submit unless you understand the terms therein.

Applicant Information: 01 First Name 02 Last Name 03 Address 04 City 05 State 06 Zip 07 Date of Birth 08 Phone 09 Cell Phone 10 Email Driver's License: 11 Number 12 State 13 Insurance Co. 14 Agent phone 15 Policy number Motorcycle Information: 16 Make, Model 17 Year 18 Vin number Registration: 19 State 20 Number Emergency Contact: 21 Name 22 Relationship 23 Address 24 City 25 State 26 Zip 27 Phone 28 Cell Phone 29 Email Designated Dealer: 30 Name 31 Address 32 City 33 State 34 Zip 35 Phone 36 Contact Sponsor Information: 37 Company 38 Address 39 City 40 State 41 Zip 42 Phone 43 Web site Rider Bio: Years riding, favorite place to ride, accomplishments, family members, etc Shirt Size: check one Small Medium Large XL XXL 3XL 4XL 5XL NOTE: Please send a head and shoulders photo for your profile to: Molly Downard - mdownard@americanmotorcyclerally.com Payment: Please make checks or money orders payable to: American Motorcycle Rally Inc. PO Box 10, Jacksontown, Ohio 43030 Pay Pal payment available on next page after submission of this form. Entry is $1,000.00 Please click Send just once and allow at least 30 seconds for this form to be sent.