EmailMe Form - 2012 Promoting Club Charter Application

Club/Chapter Name *

Contact Person Name *

First Last

Contact Person Phone *

### - ### - ####

Club Mailing Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Club Phone

### - ### - ####

Club Email

Club Web Site

Club Officers

Enter information about club officers below. In addition to the below officers, a Promoting Club must have at least five additional members with current ATVA/AMA memberships. You will be asked to provide names and ATVA/AMA numbers for these members when we call to complete your application.

President

First Last

President
ATVA/AMA Number

Legislative Officer

First Last

Legislative Officer
ATVA/AMA Number

Secretary

First Last

Secretary
ATVA/AMA Number

Referee

First Last

Referee
ATVA/AMA Number

Risk Management Officer

First Last

Risk Management Officer
ATVA/AMA Number

Risk Management Workshop

Completion of the AMA Risk Management Workshop is required annually to hold AMA-sanctioned events. The workshop is available online at http://www.americanmotorcyclist.com/clubsandpromoters/riskmanagementworkshop. Upon completion of the workshop, please submit the Affidavit of Review.

Has your club's Risk Management Officer completed the Risk Management Workshop?

Yes

No

Club Background Information

Is your club a member of your district organization?

Yes

No

Is your club incorporated?

Yes

No

What year was your club organized?

If your club donates to charitable organizations, how much did you donate during 2011?

Please select your club's primary interest.

Please select your club's AMA Congress Division.

This Club Charter Application is a:

New Application

Renewal

If this is a renewal application, include the club's existing Charter No. here: