JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Interested Member Form
Fill this out if you are interested in borrowing an e-bike!
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Name (First, Last)
*
Your answer
Email
*
Your answer
Phone Number
*
Your answer
Zip Code
*
Your answer
Age
*
0-18
18-25
25-40
40-60
60+
What do you plan to use the bike to do?
*
Your answer
Preferred method of contact
Email
Phone
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of sharedmobility.org.
Does this form look suspicious?
Report
Forms
