Safe Routes to School Giveaway Request Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Rechargeable "be seen" bike lights

Your Name *

Your E-mail *

School *

Shipping Address *

Are you planning on doing an October walk/bike to school event? *

Yes

Maybe

When is the planned date of your Walk and Roll event? *

If you have multiple days, type in as many as can fit.

What is your preference for Walk and Roll event incentives? *

Fun healthy activity temporary tattoos

Way to Go! Reflective Stickers

Would prefer to be entered into a raffle to win five USB bike lights for my school

When would you like to receive your Walk and Roll event incentives? *

If you have a tight deadline, we'll do our best to meet it.

How many materials do you need for your event? *

Let us know how many stickers/ temporary tattoos you'll need

Are there other giveaways that you would like to see us offer? Let us know.

We will look for funding sources for the most requested items.

Anything else?

Do you have any questions or concerns, or anything additional to add?

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Local Motion. Report Abuse