AMA grassroots volunteer form

* All fields must be completed


Salutation:    First:    Last:
Address:     Line 2:
City:     State:     Zip:
 Daytime Phone: ( ) -    
Evening Phone: ( ) -
        Cell Phone: ( ) -
E-Mail Address:
AMA / ATVA Number:   
*AMA membership required. Not a member? Join now!
What type(s) of riding do you participate in? (Select all that apply)

    On-road   Off-highway   ATV   Competition

Main issue(s) of concern:


1. May the AMA share your name and contact information with other AMA grassroots activists in your community / state? Yes No
2. Are you currently registered to vote?
* Not registered to vote? Register today.
Yes No
3. Are you willing to actively work with the AMA and assist with legislative issues? Yes No
4. If yes to the above question, which activities are you interested in doing?
(Select all that apply)
  Contact your elected officials
  Attend a town hall / public meeting
  Write letters to the editor
  Distribute AMA materials
  Recruit AMA members and grassroots activists
  Assist motorcycle-friendly candidate campaigns
  Contact for any / all activities

Note: By submitting this survey, you are indicating that you are ready, willing, and able to positively contribute to the way of life you hold so dear.