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(Month) ________ 2004 Monthly Rider Ed Report for Chapter/District _______

Reported by: __________________________  Level _____

How    | Number  |   Type of
Many  | of people |   Activity                                         
          |               |  MSF Experienced Rider Course (ERC) or MSF Beginner (MRC:RSS or BRC)
          |               |  Advanced Rider Course
          |               |  Sidecar Course
          |               |  Trike Rider Course 
          |               |  Trailering Course
          |               |  Parking Lot Practice (PLP)
          |               |  Other Riding Skills Course or Event
          |               |  Co-Rider Seminar (Live)
          |               |  Co-Rider Video (2002 version)
          |               |  Rider Education Related Video (Trailering, Touring & Braking, Slow Speed Cycling)
          |               |  Road Captains Course
          |               |  Other Seminar or Activity 
          |               |  Cardio-Pulmonary Resuscitation (CPR)
          |               |  First Aid
          |               |  Chapter Meeting Talks
          |               |  Newsletter Articles (hard copy plus email)
          | Number of Chapters reporting
          | Number of Chapters in your District
          | # New Level I forms processed
          | # New Level II forms processed
          | # New Level III forms processed
          | # New Level IV forms processed
          I # RENEWAL Level I forms processed
          I # RENEWAL Level II forms processed
          I # RENEWAL Level III forms processed
          I # RENEWAL Level IV forms processed