Peloton Challenge Rider Application
Please complete the form to apply for the 2017 Wellspring Ride for Cancer Support, Peloton Challenge.

If you have any questions, please contact Susan Chung at susan@wellspring.ca or call 416-961-1928 ext. 238.

Last Name
Your answer
Given Names
Your answer
Address Line 1
Your answer
Address Line 2
Your answer
City and Province
Your answer
Cell Phone Number
Your answer
Home phone number
Your answer
Email Address
Your answer
Principal Occupation
Your answer
Date of Birth
MM
/
DD
/
YYYY
Sex
How did you hear about the Wellspring Ride for Cancer Support, Peloton Challenge? (select all that apply):
Why are you interested in becoming a rider for the 2017 Wellspring Ride for Cancer Support, Peloton Challenge?
Your answer
Endurance Events
Please describe your comfort level with endurance events
Not at all comfortable
Extremely comfortable
Please describe your experience with endurance cycling:
Your answer
Cycling Experience
Please rate your comfort level with cycling:
Not at all comfortable
Extremely comfortable
Please describe your cycling background:
Your answer
How many kilometers a year do you cycle?
Your answer
What is the longest distance you have cycled in a single day?
Your answer
Fundraising
Please describe your comfort level with fundraising:
Not at all comfortable
Extremely comfortable
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