Adaptive / Assistive Equipment Support
Velo Amis support application
Name of Applicant
Your answer
Best contact email
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Best contact phone
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City and State where applicant lives
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Provide a brief description of need of applicant for adaptive equipment such as bicycle or other device that will be of help.
Your answer
Does the applicant have specific adaptive equipment that they believe would be of benefit? If so please provide a link or description of equipment.
Your answer
Is there anything else that you would like Velo Amis to know that would help us evaluate your application?
Your answer
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