Road Captain Application Form

* Below indicates a required field
Full Name *

Address *

City *

State *


Date of Birth*

PPHOG Membership # / Exp Date*

National Membership # / Exp Date*

Cell Phone & Area Code*

Home Phone & Area Code


Road Captain Duties:

  • Assist in planning and pre-riding routes for chapter rides
  • Inform Chapter members of hand signals and safety concerns during group rides
  • Assist in educating Chapter members about group riding techniques
  • Lead or sweep during organized chapter (group) rides
  • Assist in keeping the chapter informed of all HOG programs (rides and events)
  • Assist in distributing events flyers throughout the biker community
Years Of Riding Experience*

Current Road Captain*
Former Road Captain*

Never a Road Captain*
Experienced Rider Course Date:*

CPR Course Date:*

Riding References: (List 3 People who have rode with you, how long they have known you, and their phone number)
Reference 1:*

Reference 2:*

Reference 3:*

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