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) *
Your answer
Email *
Your answer
Phone Number *
Your answer
When did your bicycle related crash happen? *
Required
Zip Code of Bicycle Related Crash *
Your answer
Did you file a police report? *
Required
What type of bicycle were you riding? *
How often were you riding your bike? *
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