Stoker Registration
Membership form for TRAILBLAZERS Tandem Cycling Club
Welcome
This is the registration form for membership in trailblazers. Please complete as much of the information as you can. If you have any problems, send an email to info at trailblazerstandem dot o r g. By the way, this field is just so we can give you these instructions as Google Forms does not always play nice with screen readers. Just tab to next field and start with First Name.
First Name *
Enter your first name
Last Name *
Enter Last Name
Street Address *
Enter Street Address and include unit or apartment number
City *
Enter City
Province
enter Province. optional unless not in ontario
Postal Code *
What is your Postal Code
Main Phone Number Contact *
Enter Primary phone number. Cell Phone number is preferred.
Text messaging available? *
Is this number capable of receiving text messaging? Answer yes or no.
Phone 2
Enter your an alternate phone number here.
Email *
Enter your email address
Height *
Height in feet and inches please
Weight *
Weight in pounds please
Age
Enter your age. Question is optional but helps us when applying for grants.
Experience
enter "yes" or "no" whether you have ridden a tandem before
Personal Tandem
Enter "yes" or "no" whether you also own your own tandem
Volunteering
Please tell us if you are able to volunteer for the club Enter yes, no or leave blank if you're not sure right now.
Skills
If yes, what skills could you contribute to the club?
In Case of Emergency (Mandatory, please complete)
We need the following information in case of Emergency
Emerg Contact Name *
Emergency Contact Name
Relationship
What relationship is the above person?
Emerg Phone Number *
Emergency Contact Phone Number
Contact 2
Is there an alternate contact we could call?
Contact 2 Phone
what is the phone number for your alternate contact
Choose sheds you would like to cycle from
check boxes for the shed or sheds that you would like to cycle from. JUST LEAVE BLANK IF YOU'RE NOT SURE RIGHT NOW.
Sheds
This is another fake field so zoom text will read the description of this field. Below are check boxes for our five sheds. Select as many as you like. Tab to first field which is CNIB. By the way, JAWS correctly indicates whether box is checked, Zoom text not so good so look carefully.
CNIB
CLICK HERE FOR CNIB SHED AT BAYVIEW AND EGLINTON
EAST SHED
NEAR KENNEDY SUBWAY
FERRY DOCKS
NEAR BAY AND QUEENS QUAY
SOUTH SHED
NEAR ROYAL YORK AND LAKESHORE
WEST SHED
NEAR BURNHAMTHORPE AND WEST MALL
Schedule
Another description only field. Help us understand what time of day and week you think you will do much of your riding. Options are days, evenings, or weekends. Select any or a combination that best describes what riding you think you will do. You are never restricted to just these times. Tab now to next field.
Days
Click if you think you will ride mostly during the day monday to friday
EVENINGS
Click if you think you will ride mostly during the EVENINGS
Weekends
Click if you think you will ride mostly during the weekends.
IMPORTANT
Health Issues *
Are there Health conditions we should be aware of? (e.g. epilepsy, diabetes, Asthma, etc.) PLease enter yes or no.
Explain
If yes, please explain briefly. You may talk to us later.
Membership fee
Membership in TRAILBLAZERS is fifty dollars. Sending an E M T to treasurer@trailblazerstandem.org is preferred. Please email us for instructions if you have questions. You may also mail a check to TRAILBLAZERS, care of, Simon Berkowitz at 1 8 9 Montclair Ave. Toronto. Ontario. M 5 P 1 R 1. Tab to next field.
THANK YOU
We will be in contact with you. Please remember that we will need an original, signed copy of our Waiver Form to be submitted via email to the address shown at the bottom of the waiver, (found here on our site), or provided to us at the time of the Orientation session. Tab to next field.
Comments
Please provide comments below, or send an email to "info@TrailblazersTandem.org"
Comments
Contrary to what Google forms is saying, comments are optional. Complete as desired and tab to "submit" button. thank you.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy