Bicycle Replacement Fund Application
This application is intended for folks who have lost their primary mode of transportation, their Bicycle, to a bicycle related crash. In an effort to try and support those that need a new ride most, the Family of Emily Fredricks has started a fund to help support those in need. Please complete this application for consideration.
Name (First, Last)
When did your bicycle related crash happen?
Within the last week
Within the last two weeks
Within the last month
Within the last 6 months
A year ago
Zip Code of Bicycle Related Crash
Did you file a police report?
What type of bicycle were you riding?
How often were you riding your bike?
Most every day
A few times per week
A few times a month
A few times a year
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This form was created inside of Bicycle Coalition of Greater Philadelphia.
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