Bicycle Buddies Sign-Up 2017
*after filing out this form, please send a photo of yourself to ce.texas4000@gmail.com*

Our Bicycle Buddies program pairs a rider with someone who has been affected by cancer. This can be someone who is currently fighting, has fought cancer or someone who has been affected by a friend or family member’s cancer. Buddies communicate before and during the summer ride via phone calls, emails, texts, pictures, video chats, etc. Buddies can provide each other with support, companionship, or motivation. By participating in the program, we hope that buddies can build friendships, share stories, and inspire each other through what might otherwise be a challenging period of their lives. If you or someone you know is interested in the Bicycle Buddies program, please fill out this form. Please send any additional questions to ce.texas4000@gmail.com

First name *
Your answer
Last name
Your answer
Date of birth *
Your answer
Gender *
Your answer
Name of parent or guardian if under 18 years
Your answer
Street address *
Your answer
City *
Your answer
State *
Your answer
Zip code *
Your answer
Email address
Your answer
How did you hear about Texas 4000's Bicycle Buddies? *
What is your preferred method of communication with your Bicycle Buddy? *
How often would you want to communicate with your buddy?
If you are in Austin or our routes go through your town, would you be interested in meeting up with your buddy?
Please tell us a little bit about yourself
Your answer
What are some of your interests?
Your answer
Who do you feel comfortable sharing your picture with? *
Do you have any special buddy requests (ex: a specific rider you already know, a specific gender, etc. )
Your answer
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