2023 InTake Form
Thank you for your interest in InTandem. We look forward to you joining us!

The 2023 InTake Form has three sections: 

1.Contact Information
2. Demographic Information
3. Important Documentation.
Please complete each section below. You will receive an automatic confirmation and a dates to being your InTandem Orientation and Training.

Your contact information and emergency contact information will be shared with InTandem Staff and Volunteer Leaders who are responsible for program management, event logistics, communication and safety. Demographic information is used to better understand and respond to our cycling community, and its needs and preferences.

InTandem does not release personal information to commercial interests or other third parties.

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Contact Information: First Name *
 Last Name *
Street Address *
City *
State *
Zip Code/ Postal Code *
Preferred Phone Number *
Preferred Email Address *
Emergency Contact Info Name *
Emergency Contact Number *
Emergency Contact Email
Photo, Video and Media Release: By participating with InTandem Cycling, Inc. you are consenting to be photographed or filmed for use in  InTandem Cycling, Inc.  marketing materials. I acknowledge and hereby agree to be interviewed and/or photographed and/or videotaped and/or recorded for promotional or news documents about InTandem Cycling Inc. I understand that I will not own rights to the resulting text, photography or video, or any benefits derived therefrom. I agree to the use of my s image, name, and/or voice by InTandem Cycling Inc. or media companies discussing InTandem Cycling, Inc. and waive rights to fees associated with such use. 

Please enter your name here as acknowledgement that you have read and agreed to Photo, Video, and Media Release form:
Did you complete the 2022 InTake Form? *
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