2018 Peloton Challenge Rider Application
Please complete the form to apply for the 2018 Wellspring Peloton Challenge.

If you have any questions, please contact Aaron Lutes at aaron@wellspring.ca or call 416-480-4440 ext. 241.

Last Name *
Your answer
Given Names *
Your answer
Address Line 1 *
Your answer
Address Line 2
Your answer
City and Province *
Your answer
Cell Phone Number *
Your answer
Home phone number
Your answer
Email Address *
Your answer
Principal Occupation
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Sex *
How did you hear about the Wellspring Ride for Cancer Support, Peloton Challenge? (select all that apply): *
Why are you interested in becoming a rider for the 2018 Wellspring Ride for Cancer Support, Peloton Challenge? *
Your answer
Endurance Events
Please describe your comfort level with endurance events *
Not at all comfortable
Extremely comfortable
Please describe your experience with endurance cycling: *
Your answer
Cycling Experience
Please rate your comfort level with cycling: *
Not at all comfortable
Extremely comfortable
Please describe your cycling background: *
Your answer
How many kilometers a year do you cycle? *
Your answer
What is the longest distance you have cycled in a single day? *
Your answer
Fundraising
Please describe your comfort level with fundraising: *
Not at all comfortable
Extremely comfortable
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