Brisbane West Bicycle User Group membership signup form
Membership type
Family membership only - how many people in your family?
Number of people in your immediate family (if selected family membership type)
First Name
Your answer
Surname
Your answer
Sex
Email address
Your answer
Mobile number
Your answer
Can we contact you via text message for petitions, campaigns and events relating to your suburb?
Alternate phone number
This is optional. Input an alternative number such as home or work phone number.
Your answer
Street number
Providing your street number is optional.
Your answer
Street Name
Your answer
Suburb
Your answer
How would you describe your interest and level of confidence in cycling?
Pick the option most relvant to you.
Check all that apply. Reasons I ride a bike:
If you have selected a family membership, select reasons that apply for any family member.
Required
What specific bike routes/issues in your local area do you want addressed by Brisbane West BUG? Which suburbs?
Your answer
What other cycling-related issues do you want addressed by Brisbane West BUG?
Your answer
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