BICYCLE INTEREST FORM
Please answer the following questions to help us connect you with a bicycle.
Email address *
First and Last Name *
Phone number
Best Way to Contact me: *
City of Residence: *
Rider Age: *
Rider Height: *
MOST IMPORTANT reason for seeking a bicycle: *
I will mostly ride on: *
I would like my bike to have: (all that apply) *
Required
I think my ideal bike is a: *
Riding Ability: *
I prefer to: *
For Earn A Bike candidates, please indicate availability to volunteer. *
Some individuals may qualify for scholarship bikes, when both volunteer time and funds are limited due to circumstances. Please check any that apply to you. All answers are confidential. *
Required
Please add any comments that will help us match you with an appropriate bicycle. *
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