Alabama's Public Liberal Arts University

Alabama Traffic Safety Center

Motorcycle Safety Program
Alabama Motorcycle Rider Coach Application
(use additional space as needed)

 

 Name:

 

Address:

 

 

Home, Work, Cell Numbers:

 

 

Email address:

 

 

Riding Experience--# years, different types (off-road, touring, etc.):

 

 

 

Teaching and/or instructing experience:

 

 

 

Experience at conducting presentations of any type:

 

 

 

Educational and/or training background:

 

 

 

Any position(s) held involving any type of safety areas, plus time in the position(s):

 

 

 

Rider Education courses completed, most recent to earliest, type of course(s) and dates:

 

 

 

Briefly explain why you would like to become a Rider Coach:

 

 

 

Fax or mail completed form to:

                                         
 Alabama Traffic Safety Center
Attention: Mr. Rick Randolph
   Station 6740
    University of Montevallo
    Montevallo, AL 35115
    (205) 665-6740
    FAX (205) 665-6749

Office Hours: 8:00 a.m. - 5:00 p.m.   Monday - Friday