Welcome to the Bike2Work Signup form (Pilot Project)
Khaltsha Cycles together with 71Point4 are launching #Bike2Work pilot project to offer Khayelitsha residents an alternative mode of transport thus encouraging them to take up commuter cycling.

Please signup and let's get riding!
Name
Surname
Contact number
WhatsApp contact number
Residential Address (include postal code example Khayelitsha 7784) *
Do you have safe bicycle parking at home? *
What the name of the company you work/volunteer for? *
Contact details of you line manager for (include contact Name and Surname) *
What work are you doing for the above company? (Example: Health Fieldworker) *
Work Address (include postal code example Khayelitsha 7784) *
Do you have safe bicycle parking at work? *
What time do you start at work?
Time
:
Which of the facilities do you have at work?
Contact person in case of emergency (name and cell number) *
How do you normally commute? *
Required
Can you ride a bicycle? *
On a scale of 1 to 10 rate your fitness level *
10 Being very fit and 1 being unfit
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