Shipley Reimagined - CityConnect Baseline Monitoring
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Name *
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Date Attended
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Home Postcode *
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Date of Birth *
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Q1. Employment Status
If "Other" please specify
Q2. Place of employment/education/training?
Your answer
Q3. Do you have access to a working bike?
Q4. Why do you ride? (check all that apply)
Q5. How often do you ride?
What would encourage you to ride more? (check all that apply)
CONSENT
The information which you provide will only be used in the manner described in the attached privacy notice (https://goo.gl/C3mZMw). If you agree to allow the West Yorkshire Combined Authority (WYCA) to use your information as specified, please provide your consent by ticking the appropriate boxes below.

I consent to WYCA using my personal data above, for the purpose of monitoring and evaluating the impact of the Confident Commuter Package project managed by Bradford Capital of Cycling I understand that this may involve WYCA or someone nominated by it contacting me [by email] at a further date with a follow-up survey to assess the impact of the programme.

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* You can withdraw your participation at any time by contacting us at the following address: CityConnect Team, Wellington House, 40-50 Wellington Street, Leeds, LS1 2DE E-Mail: cityconnect@westyorks-ca.gov.uk Tel: 0113 2517366.
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