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Cyclist Information:

Full Name:

Status (check all that apply)

Phone Number Email Address

Cycling Information:

How Often Do you Ride

What type of bike do you usually ride? (check all that apply)

What is your level of riding?

What is your longest ride to date? Miles

Have you ever taken a safety class?

List any volunteer activities:


Emergency Info:
(This information is kept on file by the president only. Please remember to always have with you identification and emergency contact information when you are on the road.)

In case of emergency, contact:

Emerygency contact's phone #:

Relationship:


     
   

 

Page maintained by Department of Sports & Fitness

Last updated or reviewed on 10/22/10

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